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Washington state and Rhode Island have the best policies supporting direct care workers, while Texas and Mississippi have the worst. That’s the finding of a new ranking index developed by PHI National, a nonprofit that tracks the direct care workforce.

The rankings are based on two composite measures. The first considers policies that support the worker such as wages, training requirements, Medicaid expansion, paid leave, union rights laws and LGBTQ protections. The second measure considers economic variables, such as median wage, wage competitiveness, median annual personal earnings, affordable housing and health insurance coverage.

PHI awarded the top rankings to the following states: (1) Washington, (2) Rhode Island, (3) District of Columbia, (4) Maine and (5) New Jersey. The bottom five rankings were awarded to the following states: (51) Texas, (50) Mississippi, (49) Louisiana, (48) Alabama and (47) North Carolina.

The nonprofit said the rankings are intended to provide a critical lens on policies shaping direct care jobs across different states. However, it also said the rankings don’t fully capture the complexity and nuance of each state.

“PHI has always been committed to providing our partners and audiences with reliable research that strengthens their interventions on the direct care workforce — and this new index provides the much-needed analysis that state and national leaders have wanted for years,” Kezia Scales, PhD, PHI vice president of research and evaluation, said in a statement. 

PHI estimates the long-term care industry will need to fill an estimated 7.9 million direct care jobs by the end of the decade. The number includes existing caregivers who exit direct care for other occupations or leave the workforce entirely and jobs that are created by increased demand. 

The state of New York recently kicked off an effort to develop a master plan for aging that will include recommendations on ways to attract workers to the long-term care industry. California has developed a similar plan.