The workforce shortage has reached long-term care. We should act

In Minnesota, the vacancy rate for personal care aides has reached 14 percent, forcing families with ailing members to rely on each other, even quitting their jobs to make support possible. In Northwest Michigan, the Area Agency on Aging reports a growing waitlist of people in need of home care workers, an occupation that averages $10 an hour and is struggling to compete with fast food workers. In Wisconsin, reports depict a shortage that extends beyond paid caregivers to nurses, hospital-based dieticians, and surgical technicians. For years, experts predicted an eventual crisis of workforce shortages in health care and long-term care. Now the effects are all around us, across settings, in every part of the country.  

For home care workers and nursing assistants—the “direct care” workforce that provides the majority of hands-on, paid long-term care in this country—this shortage can be explained by low wages, meager benefits, and the marginal career advancement opportunities that are characteristic of this difficult and unsafe occupation. Workers simply don’t want these jobs. Similarly, many long-term care providers—their employers—cite low, unappealing wages as the primary impediment to recruiting direct care workers, pointing to a general lack of Medicaid funding to cover these costs.

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Without system-wide funding or an array of policy solutions, providers are left with high vacancy rates; workers walk away from these jobs; and families are left in the dark, spending their savings, dipping into retirement, and taking unpaid time off to support their loved ones, as documented by recent research from AARP. Every year, elders and people with disabilities are prematurely forced into nursing homes and hospitals as the last resort. 

If this scenario doesn’t currently resonate, it will soon. The population of people age 65 will nearly double between now and 2050—from 47.8 million to 88 million—and 70 percent of them will require some form of long-term care. Because of this surge, the Bureau of Labor Statistics estimates that we’ll need an additional 1.1 million paid caregivers to care for this population.

Unfortunately, the primary labor pool for this workforce—women, ages 25 to 64—will grow by only 1.9 million, or less than one percent in that time frame. Moreover, the turnover rate for home care workers is more than 60 percent. Everyday Americans want paid caregivers to support their parents, grandparents and other family members, but candidates aren’t taking these jobs. Even technology can’t save us when there aren’t enough people. 

A new administration should theoretically deal with a problem of this magnitude, yet early indications of the Trump administration suggest animosity toward our national health care arrangements, including Medicaid, as well as a virtual disregard for older people and people living with disabilities. We should be concerned—and we should imagine policy solutions that span the array of issues spurring this workforce shortage. For starters, we need policy reforms that expand and stabilize the direct care workforce, including higher wages, overtime protections, better health insurance, and increased access to benefits, from family leave to the EITC, and more. We need federal training standards and competency requirements for home care workers, as well as initiatives that improve training and advancement of personal care aides. We need policy supports for family caregivers, including tax credits, as well as training programs that support both paid and unpaid caregivers in meeting the needs of people with chronic conditions such as diabetes and Alzheimer’s disease. And we can all benefit from more data and research that quantifies the workforce shortage and pinpoints where interventions are most needed.

Ultimately, we need bold ideas and the dedication of our country’s most creative policy experts in aging, disability rights and the workforce. In this spirit, PHI, the country’s premier expert on the direct care workforce, will launch a two-year, national campaign, #60CaregiverIssues, on Feb. 7 to promote 60 concrete ideas that could begin remedying this workforce shortage—through policy reform and through program innovations from the full array of long-term care actors. Similarly, groups such as AARP and Caring Across Generations are tackling family caregiving and the role of paid caregivers in their national initiatives. The road to a more stable infrastructure of paid and unpaid caregivers will take many routes and require a host of drivers.

Our parents and grandparents are relying on our solutions. And one day, we will, too.

Robert Espinoza is the vice president for policy at PHI, the nation’s leading authority on the direct care workforce.


The views expressed by authors are their own and not the views of The Hill.