NEW YORK—PHI, a provider of jobs for the caregivers in the direct care workforce, released findings from an independent evaluation of the Carina matching service registry in Washington State. The report presents the first evidence that matching service registries can effectively connect homecare workers with consumers, while enhancing job quality and supporting independent living.
Conducted in 2024, the evaluation found that Carina—a nonprofit, web-based platform—has achieved success in facilitating quality matches between self-directing Medicaid consumers and individual providers (homecare workers).
Evidence of Quality Matches & Job Improvements
PHI used a comprehensive mixed-methods approach to evaluate Carina’s impact—including administrative and platform data with more than 25,000 in-app survey responses along with first-hand perspectives from nearly 600 caregivers and consumers through in-depth surveys and interviews. Carina was found to:
- Support independent living and workforce retention. Notably, 92% of consumers shared Carina has helped them remain living at home rather than move to a nursing home, and 91% of workers reported Carina has helped them stay in the workforce.
- Attract users seeking choice, control and convenience. Consumers reported that they use Carina to find caregivers who can meet their specific scheduling and care needs.
- Generate strong endorsement. With 98% of individual providers and 91% of consumers surveyed indicating they would recommend Carina to others.
- Facilitate a good "fit" between consumers and providers. A good fit was defined in terms of well-matched needs, preferences, skills and availability.
- Support lasting caregiving relationships. There were median matches of 12 to 15 months, and many matches lasted two years or more.
- Enhance job quality. This was achieved by helping workers gain better schedules and maintain health insurance. Notably, 28% of individual providers reported using Carina specifically to maintain eligibility for health insurance.
“At Carina, we believe a strong care economy supports both the people receiving care and those providing it,” says Nidhi Mirani, CEO of Carina. “This evaluation highlights how quality job matches can help caregivers meet critical needs, whether it’s finding the schedules that match their availability or the hours needed to qualify for health insurance. That’s a tangible impact on economic security for the caregiving workforce.”
Addressing Critical Workforce & Care Access Challenges
The study comes at a crucial time, as the nation faces an acute shortage of homecare workers. In Washington state alone, nearly 61,000 individuals are enrolled in self-direction programs, with approximately 30% needing to recruit caregivers from their broader communities rather than relying on family members.
"This evaluation provides compelling evidence that matching service registries like Carina are not just connecting workers and consumers—they're facilitating quality, lasting relationships that help people to remain living in their homes, while keeping workers employed in good jobs," said Kezia Scales, PHI’s vice president of research and evaluation. "These findings should inform policy decisions in states across the country that are struggling to support their growing self-direction programs."
A Model for Replication
Carina represents a replicable model for Medicaid homecare programs, rooted in a tripartite partnership between SEIU 775, Washington state and Consumer Direct Care Network Washington. Since its creation in 2016 and statewide expansion in Washington state, Carina has also launched in Oregon and built partnerships across multiple states with public agencies, employers, labor unions and community organizations to address evolving care workforce and consumer needs.
"Carina works because it gives caregivers and consumers more control, choice and convenience to find what they need,” said Mirani. “What makes it powerful is our ability to scale within—and strengthen—the care infrastructure by partnering with states, labor unions and employers. Together, we’re building a future where care work is supported and accessible.”