# Collaborative Co-design of Portable Work Benefits Policy Model and Prototype based on Direct Care Workers' Needs, Attitudes, and Beliefs

> **NIH AHRQ R36** · UNIV OF MARYLAND, COLLEGE PARK · 2022 · $43,200

## Abstract

Direct care workers (DCWs) comprise an essential, highly-skilled, rapidly growing part of the health care
workforce. DCWs assist people with disabilities and frail elders with activities of daily living. DCWs decrease
health care costs by preventing the need for institutionalization, hospitalization, and other costly medical
services among their clients. From 2016 to 2060, the number of adults aged 65 and over will increase from
49.2 million to 94.7 million. The number of adults 18 to 64 will remain the same, leading to a shortage of family
caregivers. There were 31 working-age adults for every adult aged 85 and over in 2017, but this ratio will
diminish to 12 by 2060. DCWs are expected to grow by 1.3 million from 2019 to 2029. This growth will not keep
pace with the projected growth of people with disabilities and frail elders. The turnover rate among DCWs is
already high due to poor work conditions and inadequate compensation, with more people leaving the
workforce than entering it. It is critical to explore ways to improve DCW working conditions and compensation
to prevent further shortages in the workforce. Although DCWs contribute enormously to public health, their
health is put at risk due to the nature of the work, low wages, and lack of worker protections and traditional
work benefits. DCWs are vulnerable to injury, abuse, infectious diseases, and other poor health outcomes due
to the previously listed disadvantages. The DCW workforce in the United States is predominantly comprised of
priority populations: female, racial or ethnic minorities, and one in four workers are immigrants. The risks that
DCWs face exacerbates existing health disparities among these priority populations. There is compelling
evidence that work benefits improve health outcomes. Work benefits also protect clients of DCWs from
healthcare-associated infections as DCWs would be able to take paid sick leave when ill. Portable work
benefits are work benefits that employees can take with them from job to job, prorated so that multiple
employers (like clients) can contribute, and accessible to all workers. Portable work benefits are not widely
available but have been proposed as an innovative way for workers who lack work benefits can receive them.
We propose to 1) conduct focus group discussions to explore the needs, attitudes, and beliefs of DCWs
regarding portable work benefits; 2) hold two co-design sessions and a focus group session with DCWs to
develop and refine a portable work benefits policy model for DCWs in Maryland (with agency representatives
invited to the second co-design and focus group sessions), and 3) hold a co-design session and a focus group
session for adapting and further refining portable work benefits apps and websites for DCWs. This study will
provide a first step toward obtaining DCWs work benefits that will protect their health and those around them,
improve work conditions and compensation, and prevent further workforce shortages among DCWs. Thi...

## Key facts

- **NIH application ID:** 10560116
- **Project number:** 1R36HS028934-01A1
- **Recipient organization:** UNIV OF MARYLAND, COLLEGE PARK
- **Principal Investigator:** Charlene Chao-Li Kuo
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $43,200
- **Award type:** 1
- **Project period:** 2022-09-30 → 2024-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10560116

## Citation

> US National Institutes of Health, RePORTER application 10560116, Collaborative Co-design of Portable Work Benefits Policy Model and Prototype based on Direct Care Workers' Needs, Attitudes, and Beliefs (1R36HS028934-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10560116. Licensed CC0.

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