{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T08:49:49Z","timestamp":1766134189409,"version":"3.41.2"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000867","name":"the Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["grant no. 82613"],"award-info":[{"award-number":["grant no. 82613"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Southern states face severe home care labor shortages due to low wages, poor working conditions, and limited career advancement opportunities, which are exacerbated by the region's historical labor policies and economic inequalities. This study analyzed workforce size in relation to the population of older adults likely to require paid home care services, subsequently contextualizing those results using a thematic analysis of state American Rescue Plan Act section 9817 spending plans to identify trends in proposed initiatives designed to strengthen the workforce across the region. Our findings highlight significant disparities in workforce availability, with more diverse areas with higher concentrations of Hispanic, immigrant, and low-income populations exhibiting higher workforce capacity compared with less diverse regions. We also found consensus across states on the inadequacy of direct care worker wages, demonstrated by the large number of proposed reimbursement rate increases included in the state spending plans.<\/jats:p>","DOI":"10.1093\/haschl\/qxaf031","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T09:37:02Z","timestamp":1741772222000},"source":"Crossref","is-referenced-by-count":2,"title":["Supporting the home care workforce across the Southern United States: impetus, exploration, and policy strategies"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7306-6721","authenticated-orcid":false,"given":"Britt","family":"Sanderson","sequence":"first","affiliation":[{"name":"Applied Research and Analytics, Department of Population Health, Altarum Institute , Arlington, VA 22201 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4425-732X","authenticated-orcid":false,"given":"Sam","family":"Obbin","sequence":"additional","affiliation":[{"name":"Health Economics and Policy, Department of Population Health, Altarum Institute , Arlington, VA 22201 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5640-0334","authenticated-orcid":false,"given":"Kiera","family":"Williams","sequence":"additional","affiliation":[{"name":"Applied Research and Analytics, Department of Population Health, Altarum Institute , Arlington, VA 22201 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3193-619X","authenticated-orcid":false,"given":"Stephen","family":"McCall","sequence":"additional","affiliation":[{"name":"Health Economics and Policy, Department of Population Health, Altarum Institute , Arlington, VA 22201 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8252-0041","authenticated-orcid":false,"given":"Matt","family":"Michaelson","sequence":"additional","affiliation":[{"name":"Applied Research and Analytics, Department of Population Health, Altarum Institute , Arlington, VA 22201 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"author":"American Community Survey","key":"2025031209365019000_qxaf031-B1"},{"issue":"10","key":"2025031209365019000_qxaf031-B2","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1377\/hlthaff.2022.00483","article-title":"Personal care aides: assessing self-care needs and worker shortages in rural areas","volume":"41","author":"Chapman","year":"2022","journal-title":"Health Aff."},{"author":"Chandra Childers","key":"2025031209365019000_qxaf031-B3"},{"issue":"5","key":"2025031209365019000_qxaf031-B4","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1377\/hlthaff.2022.01351","article-title":"The home care workforce has not kept pace with growth in home and community-based services","volume":"42","author":"Kreider","year":"2023","journal-title":"Health Aff."},{"issue":"3","key":"2025031209365019000_qxaf031-B5","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1177\/2332649219885980","article-title":"Reproducing the privilege of white femininity: an intersectional analysis of home care","volume":"6","author":"Curington","year":"2019","journal-title":"Sociol Race Ethnicity"},{"issue":"9","key":"2025031209365019000_qxaf031-B6","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1001\/amajethics.2022.860","article-title":"A case for federal labor legislation to protect underpaid home care workers","volume":"24","author":"Rend\u00f3n","year":"2022","journal-title":"AMA J Ethics."},{"author":"U.S. Bureau of Labor Statistics","key":"2025031209365019000_qxaf031-B7"},{"author":"Tyler","key":"2025031209365019000_qxaf031-B8"},{"author":"Shea","key":"2025031209365019000_qxaf031-B9"},{"author":"Halperin","key":"2025031209365019000_qxaf031-B10"},{"author":"ARP Section 9817 State Spending Plans and Narratives and CMS Approval Letters","key":"2025031209365019000_qxaf031-B11"},{"author":"Bates","key":"2025031209365019000_qxaf031-B12"},{"author":"Kentucky Department for Medicaid Services","key":"2025031209365019000_qxaf031-B13"},{"author":"State of Alabama Independent Living (SAIL) Waiver","key":"2025031209365019000_qxaf031-B14"},{"author":"Virginia Quarterly Spending Plan for Implementation of American Rescue Plan Act of 2021 Section 9817: Federal FY 2023 Q3","key":"2025031209365019000_qxaf031-B15"},{"author":"Harrington","key":"2025031209365019000_qxaf031-B16"},{"author":"Hillman","key":"2025031209365019000_qxaf031-B17"},{"author":"Health Workforce Projections","key":"2025031209365019000_qxaf031-B18"},{"author":"Direct Care Workers in the United States: Key Facts 2024","key":"2025031209365019000_qxaf031-B19"},{"author":"Va. 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