Paraprofessional Healthcare Institute

At a Glance

National Office: 
400 East Fordham Road 11th Floor
Bronx, NY 10458
Phone: 718-402-7766

Jodi M. Sturgeon
People Served: 
Year Founded: 
Tax ID: 

Focus area(s):

Health Services/Access
Job/Career Development
Economic Development

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PHIworks to transform eldercare and disability services. We foster dignity, respect, and independence―for all who receive care and all who provide it. The nation’s leading authority on the direct-care workforce, PHI promotes quality jobs for low-income workers as the foundation for quality care for elders and people with disabilities.


Our nation’s growing direct-care workforce now includes more than 4 million home health aides, certified nurse aides, and personal care attendants. PHI works with employers, consumers, labor advocates and public-policy makers to strengthen these jobs, to help unemployed women and their families to achieve economic independence. We not only develop recruitment, training, supervision, and person-centered caregiving practices, but also advocate for the public policies necessary to support them. 


PHI builds our practice and policy efforts from the lessons of our training and employment program in Bronx, NY, which has served more than 8,500 low-income job-seekers, primarily women of color, and ensured high-quality home care for thousands more low-income elders and people with disabilities in New York City.

Impact and Outcomes

Each year, PHI impacts the lives of tens of thousands of low-income workers, elders, and people living with disabilities.

Mission & Goals

PHI’s mission is to elevate the quality of direct-care jobs across the long-term care spectrum, bringing stability to home care work and establishing it as a means to help women and their families achieve economic independence. For this workforce, we aim to both raise the floor by improving entry-level direct-care jobs, and build ladders by creating opportunities for career advancement.


Direct-care workers—including home health aides, certified nurse aides, and personal care aides—serve as lifelines to clients. They assist with activities of daily living, provide social connection, and play an essential role in the health and well-being of their clients, whether at the client’s home or in a nursing home or assisted living facility. Demand in this field has grown significantly.


Direct-care workers account for 30 percent of the nation’s health care workforce, far outnumbering other health care practitioner occupations such as physicians, nurses, and therapists. By 2020, direct-care workers will number 5 million, becoming the nation’s largest occupational group, and exceeding retail salespersons, K-12 teachers, all law enforcement and public safety workers, fast food and counter workers, and registered nurses.


However, direct-care jobs are typically poor-quality, offering inadequate training, low pay, limited benefits, unsupportive working conditions, and few opportunities for advancement. For the millions of low-income women of color who comprise the majority of the direct-care workforce, and the millions of Americans who rely on the care they provide, this lack of investment can be devastating. High turnover among direct-care workers translates to poor-quality care for elders and people with disabilities.


At the same time, significant federal, state, and local reforms are changing the way health care is delivered. PHI is leveraging our expertise to support high-road employers in responding to these changes in ways that strengthen outcomes for workers and consumers – at a critical time for both constituencies.


In our policyefforts, PHI works with federal agencies, such as the Centers for Medicare & Medicaid Services and the U.S. Department of Labor.  Our staff experts engage with stakeholders and policy makers in more than ten states, promoting higher wages, increased access to benefits, and better training and supervision for direct-care workers.


In our practiceefforts, PHI provides consulting assistance to more than 25 home care agencies and nursing homes, including some of the nation’s largest and best known. By helping these employers adapt field-tested practices, we raise the profile of the direct-care workforce, ensure effective integration in care teams, and build the case for additional investment. PHI also offers entry-level, in-service, and incumbent worker training curricula to strengthen training for direct-care staff. 


Our practice work is anchored in New York City, where PHI’s affiliated service network that provides high-quality home care for thousands of elders and people with disabilities, including Cooperative Home Care Associates(CHCA), a South Bronx home care agency owned by its 2,100 employees, and Independence Care System(ICS), a nonprofit managed care program that serves 5,130 individuals living with physical disabilities.


CHCA was the first home care agency to become a Certified B Corporation by the nonprofit B Lab, which promotes social and environmental performance, accountability, and transparency in businesses. For the second year in a row, CHCA earned B Lab’s “Best for the World” status in 2014.


The outcomes of PHI and CHCA’s training and employment program are evaluated through the Workforce Benchmarking Network – which uses program data from workforce development nonprofits from across the country to demonstrate performance benchmarks in the field.


In Philadelphia, PHI also founded Home Care Associates, a 200-employee, worker-owned home care agency and training program.


Through our online and social media channels, PHI is the nation’s primary source for direct-care workforce news and analysis—anchored at



PHI develops recruitment, training, supervision, and person-centered care-giving practices, and advocates for the public policies necessary to support them. State and federal policymaking is integral to ensuring high-quality jobs in this sector, not only to ensure minimum wage and overtime protection for this workforce, but also because a significant portion of long-term care expenses are funded through Medicaid. State policies govern training and credentialing requirements for direct-care workers, and also influence workers’ hourly wages and overall compensation – as the state reimburses health care providers at a set rate for each hour of direct-care services provided to Medicaid beneficiaries.  

Our training and employment program in the Bronx, which has provided more than 8,500 women with job opportunities to date.  Notably, a late 2013 Workforce Benchmarking Network analysis showed our entry-level training outcomes exceeding the 75th percentile among workforce development programs in New York City and across the country, at three months, six months, and a year.

Other examples of PHI’s recent impact in practice and policy include:

Φ    Personal and Home Care Aide State Training (PHCAST): Established under the Affordable Care Act, this three-year, $15 million demonstration program enabled six states to strengthen their personal and home care aide workforces―by developing core competencies and curricula, training, and certification programs. PHI secured contractual assistance roles in four PHCAST states: Michigan, California, Massachusetts, and North Carolina.

Φ    Fair Labor Standards Act: Along with our national allies, PHI contributed five years of research, advocacy, and public awareness to narrow the “Companionship Exemption” of the Fair Labor Standards Act, which denied minimum wage and overtime protection to home care workers. The U.S. Department of Labor issued a final rule in September 2013 to extend FLSA’s wage and hour protections to home care workers. These changes are set to go into effect January 2015; ensuring that implementation takes place in a timely, effective way remains an ongoing PHI effort.

Φ    Wage Parity in New York: Following advocacy efforts by PHI and partners, New York passed the Wage Parity Law in 2011, which established a wage floor for home health aides in the downstate metropolitan area at $10 per hour -- New York City’s living wage. At the time, home health aides were earning $8 per hour. The law allowed incremental increases each year since then, and as of March 2014, home health aides earn a minimum of $10 per hour.

Φ    City University of New York (CUNY) Collaboration: To improve training and employment outcomes for NYC home health aide trainees, the New York Alliance for Careers in Healthcare (NYACH) requested that PHI and CUNY pilot a program replicating key elements of our employer-based training model. The pilot has used targeted outreach through selected Workforce 1 Centers, with employers committing to hire all graduates, and it has seen PHI tailor its entry-level curriculum for pilot sites at Queensborough and Lehman Colleges.

Φ    U.S. Centers for Medicare and Medicaid Services (CMS): Funded by CMS, The National Direct Service Workforce Resource Center assists state policymakers in improving direct-care worker recruitment and retention. Through a three-year, $375,000 contract, PHI has served as a part of a consortium providing technical assistance to select states, particularly those participating in Money Follows the Person and the National Balancing Indicator Project.

Φ    Homecare Aide Workforce Initiative (HAWI): This initiative, implemented in collaboration with the UJA-Federation of New York and the Harry and Jeanette Weinberg Foundation, reached more than 1,060 low-income individuals through entry-level and specialty (incumbent) trainings by September 2014. Supporting UJA-Federation sites with recruitment, training, and employment efforts, PHI has worked to create a framework for best practices in training and employment accreditation that can be applied citywide and across the country.

Φ    PHI State Data Center: Funded in part by CMS, this newly launched online resource ( provides up-to-date profiles of the direct-care workforce in all 50 states―including key workforce statistics, training requirements, and information on state initiatives to improve these jobs.

Φ    Impact in a growing number of states: PHI practice staff, including our Workforce and Curriculum Development and Coaching and Consulting Services staff – are helping employers, state surveyors, training organizations, and others in a growing number of states across the country to improve the quality of direct-care jobs – and improve care for elders.

Growth Plan

PHI is forging a national strategy of systems change within the eldercare and disability services sector. The important changes taking place in New York’s health care policy have positioned PHI to leverage our expertise to shape health care and improve job quality for essential caregivers. As more states follow suit in the transition to managed care, PHI’s lessons learned in New York will produce meaningful outcomes across the country.

Within the next five years, we will:

PHI will significantly increase our measurable outcomes. As we do, we aim to demonstrate the feasibility of our caregiving and workforce innovations in the large-scale systems that dominate the healthcare landscape.

•    Coordinating care for 8,000 low‐income elders and people with disabilities, with our partnering managed care plan, Independence Care System -- keeping pace with New York State’s transition to managed long-term care
•    Employing 3500 home care aides at PHI’s partnering home care agency, Cooperative Home Care Associates -- the nation’s largest worker-cooperative
•    Each year, training 720 women facing long-term unemployment or newly entering the workforce -- offering them a chance to begin careers in healthcare

Leverage our Scale to Change a Field
With lead support from the John A. Hartford Foundation and the F.B. Heron Foundation, PHI is expanding our technical assistance and advocacy capacity through a multi-million dollar “Philanthropic Equity” campaign.

The resulting grant investment will allow PHI to expand our consulting, policy, and advocacy staff to 30 professionals, and to diversify our revenue base to a 50/50 blend of grant and fee-for-service income. We will leverage our practice and policy “lessons learned” to other large employers, training programs, and care coordination plans, and into research and advocacy for changes in public policy, on a much broader scale.

Maximize Impact
PHI will achieve large‐scale practice changes within major employers, managed care plans and direct‐care training programs—as well as system‐wide policy changes in federal and state legislation and regulations.

Location of Sites

National Office: 
400 East Fordham Road 11th Floor
Bronx, NY 10458
Phone: 718-402-7766
List of locations

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Major Funders


The Achelis Foundation
Altman Foundation
The Atlantic Philanthropies
Booth Ferris Foundation
Capital One Bank
The Clark Foundation
The Ira W. DeCamp Foundation
Ford Foundation
The Bernard F. & Alva B. Gimbel Foundation, Inc.
The F.B. Heron Foundation
The John A. Hartford Foundation, Inc.
W.K. Kellogg Foundation
The Charles Stewart Mott Foundation
New York Alliance for Careers in Healthcare
The New York Community Trust
Pinkerton Foundation
Robin Hood Foundation
Eleanor Schwartz Foundation
The Starr Foundation
The Stavros Niarchos Foundation
Surdna Foundation
Henry and Marilyn Taub Foundation
Tiger Foundation
United Hospital Fund
The Harry and Jeanette Weinberg Foundation
The Woodcock Foundation

Key Contracting Organizations

New York State Department of Health
New York State Office of Temporary and Disability Assistance
Michigan Department of Community Health
Detroit Regional Workforce Fund
Center for Medicare and Medicaid Services (CMS)/ The Lewin Group
CMS/Health Management Solutions
UCSF – National Institute on Disability and Rehabilitation Research
Fairpoint Baptist Homes
Trinity Senior Living Communities