Lawmakers urged to act on expanding Iowa's direct care workforce

The House Chambers in the Iowa Capitol is seen in 2018 in Des Moines. (The Gazette)
The House Chambers in the Iowa Capitol is seen in 2018 in Des Moines. (The Gazette)

DES MOINES — Lawmakers are being encouraged to push forward legislation to address the needs of Iowa’s aging population and those with disabilities who rely on the direct care workforce.

It’s hardly a new issue, advocates told a House Human Resources subcommittee Tuesday on House File 402, which calls for expansion of the federally required direct care worker registry to include all certified nursing assistants regardless of their employment setting.

“Year in and year out, the Legislature has discussed the need to build a larger and more sustainable direct care workforce,” John and Terri Hale, whose consulting firm advocates on caregiving issues, wrote to the subcommittee.

However, they said, lawmakers have never dealt with the registries and data collection mechanisms needed to document the size of the workforce, how much turnover occurs every year and why, and the future needs and development of a plan to meet the ever-growing demand for direct care workers.

The current system is based on laws written more than 40 years ago when nursing homes were the only extended care options, according to Di Findley of Iowa CareGivers. Fortunately, she wrote, Iowans have more options today. However, “the antiquated system has not kept up with the new ways of delivering health and long-term care services.”

HF 402 has evolved from previous legislative proposals and is the result of input from many stakeholders, said Amy Campbell, who represented Iowa CareGivers, AARP Iowa and Iowa Association of Area Agencies on Aging, all groups supporting the bill.

“The direct care workforce is in crisis right now,” Campbell said.

According to AARP Iowa, 42 percent of Iowa nursing homes face staffing shortages. COVID-19 has contributed to shortages throughout the direct care industry.


The Iowa Association of Community Providers, which has members for and against HF 402 among its 140 provider members who employ 30,000 people and serve more than 160,000 Iowans, warned that the expansion could make the registry unwieldy.

One of the challenges is numerous agencies and departments are involved in one way or another, Campbell said. That can make it difficult to have a focused plan to address workforce issues.

The bill would expand the existing direct care workforce registry to include all CNAs. Currently, only long-term care facilities are required to report qualifying employment to the registry.

That would benefit direct care workers, people with disabilities, older Iowans, family caregivers, long-term care services employers and the state, Findley said.

Comments: (319) 398-8375;

Give us feedback

We value your trust and work hard to provide fair, accurate coverage. If you have found an error or omission in our reporting, tell us here.

Or if you have a story idea we should look into? Tell us here.