Respite WorkforceCareer lattices deepen a worker's expertise within their current role — through a credential, certification, or badge — without changing their job title or scope of practice. A respite worker who becomes a dementia care specialist while continuing to support the same client is following a lattice. Career ladders lead to a new role with expanded responsibilities, often through new certification or licensure.
In direct care, ladders too often assume a single path: from direct care worker to nurse. For many workers, that path is out of reach — and out of step with what they want. As PHI's Caring for the Future report (2021) found, workers consistently seek new skills and fairer pay while seeing direct care itself as their career, not a stepping stone. More accessible, specialized pathways create meaningful advancement — and higher-quality, more customized care.
The resources below show how organizations and other sectors have built these pathways, spanning entry-level training through advanced credentials. As you design opportunities for your own respite workers, involve them in the process, and make sure each pathway serves workers, employers, and the people receiving care.
From RCAW, NASHP, and ARCH NRCPT
An entry-level competency-based respite provider training curriculum, designed for people interested in providing respite care to individuals with varying disabilities and ages across the lifespan. Available in English and Spanish.
From Wisconsin DHS and UW-Green Bay
A new job category and FREE training program to encourage potential workers to join the direct care workforce. Completers can provide personal care and supportive home care for older adults and individuals with disabilities.
From University Wisconsin Green-Bay
After completing CDCP training in Wisconsin, individuals can earn microcredentials in specific areas of expertise including dementia/memory loss, family and community health, and universal skill building. Approved by Wisconsin DHS.
From University of Wisconsin – Oshkosh
Flexible, on-demand courses (1-2 hours each) to build skills in substance use disorder and medication diversion, preventing misconduct, compassion fatigue, preventing violence, dementia, and more. Contributes to continuing education requirements.
From Community Outreach Wisconsin
Training series supporting caregivers for those with intellectual and developmental disabilities. Meets continuing education requirements of Wisconsin Department of Regulation and Licensing. Available in-person and virtual settings.
From PHI
The Care Integration Senior Aide (CISA) position represents a career advancement opportunity for direct care workers. Reviews CISA implementation in Wisconsin, demonstrating how advanced roles can transform care delivery while creating career advancement.
From PHI
A 10-step implementation guide for the CISA role with specific recommendations on data collection to help build an evidence base for return-on-investment and demonstrate cost-effectiveness and impact.
From Care Providers of Minnesota, LeadingAge Minnesota, and MN DHS
Career pathway tool showing variety of jobs in LTSS, from caregiving to therapy, housekeeping, culinary, and life enrichment. Each job title includes duties, growth opportunities, available roles, skills needed, experience required, and salary range.
From DC Health Care Workforce Partnership
Career map demonstrating pathways through and beyond the home health aide position, highlighting five specific high-demand pathways in the DC area. Notes job titles, education requirements, and associated wages. Includes a quiz for job seekers.
From Northwell Health
Career path outlining a potential pathway specific to Licensed Practical Nurses through a home care agency. A good example of how an individual employer can develop professional steps for employees to follow.
From Wisconsin Department for Public Instruction and Pathways Wisconsin
Identifies specific job titles and categories for jobs in direct patient care based on education level. Links to additional information on knowledge, skills, abilities, job duties, personality traits, and job outlook.
From Missouri Economic Research and Information Center
Career ladder resource offering recommendations on pathways for home health aides and personal care aides in a "Now, Next, and Later" framing. Each step notes salary range and certificates required to move up.
From Susquehanna Workforce Innovation Partnership
Career pathway map offering variety of career "zones," with a color-coded display of how zones move through a specific field of work. Click job titles to learn more about education requirements and other details.
From Bell Policy Center
Maps three separate career paths for personal care aides in nursing, health education, or therapy services. Also details how to build ladders within your organization, including stackable credentials and public-private partnerships.
From Colorado Workforce Development Council
Non-industry specific guide offering intensive instruction on how workforce centers, education systems, industry leaders, and training organizations can partner together to build career pathways for job seekers.
Research supporting the need for career development and advancement opportunities across the direct care workforce.
Hostetter, M., & Klein, S. (2021, July 1). Transforming Care. The Commonwealth Fund.
PHI. (2025, July 10). PHI launches Universal Direct Care Workforce Initiative.
U.S. Chamber of Commerce Foundation. (n.d.). Workforce development and training.
Scales, K. (2018, May 13). Growing a strong direct care workforce. PHI.
PHI. (n.d.). Advanced Roles. PHI.
Campbell, S., Del Rio Drake, A., Espinoza, R., & Scales, K. (2021, January 12). PHI.
Magan, G. (2023, October 23). LeadingAge LTSS Center @ UMass Boston.
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