It’s a startling news story. A new study from the University of California at San Francisco estimates that the long-term care system will need 2.5 million more professionals within the next 15 years to support growing populations of elders and people with disabilities. Within that workforce, direct-care workers—nursing aides, home health aides, and personal care aides—are the fastest-growing segment and lowest paid. Worsening this scenario is that family caregivers are increasingly strained to provide care—all of which begs the question: who will care for us as we age?
The White House Conference on Aging—held every decade to address the top issues facing older adults—provides the space to begin answering that question. Already the conference has selected four primary policy topics: healthy aging, elder justice, retirement security, and long term services and supports.
It’s the latter subject that preoccupies PHI’s efforts as a national organization focused on strengthening the direct-care workforce. Our work with eldercare and disability service providers, as well as our national research and policy initiatives, routinely reveal this dilemma: unless we invest in large-scale solutions that strengthen the quality of jobs for this workforce, the supply of workers will shrink and the people we love will not be able to access the care they need as they age. Keep in mind, direct-care workers provide most of the paid, hands-on care for individuals who have age-related functional limitations.
Here are some points to consider during this national conference:
Quality care for elders and people with disabilities begins with quality jobs for direct-care workers. Better quality jobs improve retention of current workers, and also make this sector more appealing to future professionals who can help meet the growing demand. Consider that direct-care workers earn on average $9.71 an hour; occupy grueling jobs with high injury rates and unreliable, part-time hours; and often turn to public benefits to remain financially afloat. In turn, nearly one in two workers leaves her job within 12 months, citing wages as the primary reason.
Direct-care workers, in order to deliver quality care, require initial and on-going training. The care that this workforce provides requires increasingly complex skills—for example, dementia care or helping individuals manage heart disease or diabetes--to meet the varied health and daily living needs of older people and people with disabilities. Good training not only improves care but protects workers from on-the-job injuries that make direct-care workers miss work more often than even construction workers. Training also has workforce benefits: research shows that it can improve job satisfaction and confidence, while reducing high turnover.
Career advancement opportunities for direct-care workers, as well as innovations in technology, will become more critical in the years ahead. As with any industry, direct-care workers seek out—and financially rely on—career advancement opportunities. Additionally, technology in long-term care is increasingly being used to increase information sharing between workers and their employers, to enhance the interactions between a health professional and the person obtaining care, and to connect family members with companies providing care. To ensure we don't run out of long-term care workers, the long-term care system will need to invest in technological innovations while making direct-care career opportunities more appealing to future generations.
Where do we start? Better wages and benefits will keep direct-care workers out of poverty and will keep these jobs competitive with other industries. When it goes into effect, a contested 2013 Department of Labor ruling will ensure minimum wage and overtime protections for home care workers—a first step toward raising the wage floor.
A properly compensated direct-care workforce assumes that the long-term care system is properly financed and that its providers -- that employ direct-care workers and determine compensation -- are properly reimbursed for the actual cost of services. Neither assumption holds true, in our experience. New managed-care regulations issued by the Centers for Medicare and Medicaid Services are one opportunity to address underfunding. If providers aren’t reimbursed in a timely manner for the care they provide, their abilities to compensate their workforce will suffer, and so will our ability to access care.
Training standards and requirements for direct-care workers can draw from a variety of assessments, including a forthcoming report to Congress from the Health Resources and Services Administration on training standards for personal care aides. The fastest-growing direct-care occupation, personal care aides are currently subject to no federal training standards.
Finally, the federal government could invest in projects that train direct-care workers and family caregivers on how to provide better care as a team, develop a range of career ladders for this workforce, and support telehealth and technology interventions that enhance the professional interactions among workers, employers, clients and their loved ones.
This historic White House conference is anticipating the aging trends over the next 10 years. It's difficult to imagine an issue more pressing to the state of eldercare than the workforce delivering it. If we can’t access the care we need as we age, because the workforce left for other jobs, can we reasonably state that we are prepared to care? And what then?
Espinoza is PHI vice president of policy.