NATIONAL CENTER FOR HEALTH STATISTICS

National Post-acute and Long-term Care Study 

Direct Care Worker Pilot

Manisha Sengupta PhD, Christine Caffrey PhD, and Jessica Lendon PhD, NCHS

Marie Squillace PhD, ASPE

Angela Greene MS, MBA and Melissa Hobbs MA, RTI International

2023 Federal Committee on Statistical Methodology Research and Policy Conference

October 25, 2023
Disclosure

 None of the authors have any conflicts of interest to disclose.

 The findings and conclusions in this presentation are those of the authors 

and do not necessarily represent the official position of the National Center 

for Health Statistics, Centers for Disease Control and Prevention; Office of 

the Assistant Secretary for Planning and Evaluation, Department of Health 

and Human Services, or RTI International. 
Direct care workers – a snapshot

 Who are direct care workers? Direct care workers assist older adults and people with 

disabilities with essential daily tasks and activities across a range of long-term care settings.

 Occupational titles: Certified nursing assistants, nursing assistants, home health aides, home 

care aides, personal care aides, personal care assistants, and medication technicians or medication 

aides

 Job growth: Over the past decade, the direct care workforce added nearly 1.6 million new jobs, 

growing from 3.2 million workers in 2012 to 4.8 million in 2022. Expected to add just over 1 million 

new jobs from 2021 to 2031—more new jobs than any other single occupation in the country.

 Income: Median annual earnings for direct care workers are just $23,688. Thirty nine percent of 

direct care workers live in low-income households (defined as subsisting at less than 200 percent of 

the federal poverty level), and 46 percent rely on public assistance, such as Medicaid, food and 

nutrition assistance, or cash assistance.

 Demographics: Large majority are women of color; a substantial proportion are immigrants.

Source: PHI Workforce Data Center estimates, based on U.S. Bureau of Labor Statistics, Occupation Employment Statistics data, 2022. 

Data is available directly from BLS: https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm; 

https://www.bls.gov/ooh/healthcare/nursing-assistants.htm.
Direct care workers, COVID-19 crisis, and the lack of 

data

 Impact of COVID-19

– Increased need for direct care workers 

– Need to improve the lives of direct care workers in order to reduce turnover

– Pressing need for appropriate training and job quality interventions in order to improve 

quality of care received by older people and people with disabilities

 Direct care workforce surveys 

– 2004 National Nursing Assistant Survey – a supplement to the 2004 National Nursing 

Home Survey

– 2007 National Home Health Aide Survey – a supplement to the 2007 National Home and 

Hospice Care Surveys
National Post-acute and Long-term Care Study 

(formerly National Study of Long-Term Care Providers)
NPALS – Direct Care Worker (DCW) Pilot Study

 Purpose: To design and test a sampling protocol, questionnaires, and contact 

strategies that could be used in a national DCW survey in the future.

 ASPE & NCHS Collaboration

 Data collection contractor: RTI

 3 NPALS settings: Adult day services centers, Nursing homes, Residential care 

communities

 Certified nursing assistants, nursing assistants, home health aides, home 

care aides, personal care aides, personal care assistants, and medication 

technicians or medication aides are included.
DCW: Frame and Sampling Design

Two- Stage Probability Design

Sample of 120 ADSCs 

from a list of ADSCs 

eligible for 2022 NPALS

100 DCWs

Sample of 120 NHs from 

CMS’ list of all active 

Medicare-certified NHs)

Sample of 120 RCCs 

from a list of RCCs 

eligible for 2022 NPALS

100 DCWs 100 DCWs
DCW: Respondent Contact Materials

 Directors

• Welcome letter signed by 

NCHS Director

• Frequently Asked Questions

• CATI confirmation and 

sampling prep letter

 Direct care workers

• Welcome letter signed by 

NCHS Director

• Frequently Asked Questions

• Confidentiality brochure

• Flyer
DCW: Data Collection Protocol

 Data collection includes three components: 

1. Telephone call for directors to set up the sampling appointment and 

confirm eligibility

2. Telephone call for the directors to sample two DCWs and answer a 

few questions about the sampled DCWs

3. A mail/web questionnaire for the two sampled DCWs to complete 
Calls with the Director

 During eligibility and sampling calls

• Confirm have at least one resident/participant and DCW

• Walk through sampling list with the director. 

• Remove DCWs that are not eligible—language barrier, not current employee or contractor 

 For each sampled DCW ask:

• Is the sampled DCW an employee or a contractor? 

• If employee, does the DCW work part-time or full-time? 

• If contractor, does the DCW contract temporarily or long-term? 

• What is the position title of the sampled DCW?

• Could I please have the name, address, phone number, and email 

address of the sampled DCW?
DCW Questionnaire

 TEP Meeting – December 6, 2022

 Questionnaire Topics

• Training

• Job history

• Work setting

• Wages

• Benefits

• Family life

• Demographics
DCW: Challenges and Alternative Strategies

 Challenges

• Small sample and low response: difficulty reaching directors

• Directors refusing to sample

• Directors refusing to provide names of and contact information for DCWs

 Alternative strategies

• Send the questionnaire packets to sampled DCWs at the facility address

• Director forwards email to sampled DCWs – the email contains links to the 

webpage and phone number

• Director distributes email to all DCWs – the email contains links to the 

webpage and phone number

• Director distributes flyers to all DCWs about participating in the study.
Advantages of combining an establishment survey and 

a worker survey

 Methodological advantages

 Expedite the conduct of the survey

 Reduce survey costs and respondent burden

 Improve participation

 Increase the analytic potential of both the establishment survey 

and the worker survey
Future Possibilities

 National direct care worker study- 5 sectors (adult day services centers, 

residential care communities, nursing homes, hospice, and home health care)

 Extend to other sectors

• Home care

o Frame 

o Questions added to 2024 frame development process

• RCCs exclusively serving residents with Intellectual and 

developmental disabilities (IDD) and Severe mental illness (SMI)

o Frame - 2018 NSLTCP/NPALS

 Develop relevant questions including eligibility questions

 Pilot test
More information about the DCW pilot...

Respondent contact materials and DCW questionnaire can be found at the 

NPALS DCW Pilot participant webpage

https://www.cdc.gov/nchs/npals/dcw_participants.htm

More information about the NPALS...

 National Post-acute and Long-term Care Study

https://www.cdc.gov/nchs/npals/index.htm

 Long-Term Care Dashboard: Biennial Overview of Post-acute and Long-term Care in 

the United States

https://www.cdc.gov/nchs/npals/webtables/overview.htm
Thank you!

Contact Information:

Manisha Sengupta: msengupta@cdc.gov

Christine Caffrey: ccaffrey@cdc.gov

Jessica Lendon: jlendon@cdc.gov