The Long-Term Services Workforce
A well-trained and reliable long-term services workforce is vital to providing high-quality long-term services. Today, we are facing a shortage of workers across all levels of long-term services delivery: home health aides, personal attendants, nurse assistants, and geriatricians. Shortages are predicted to become more severe in the years ahead.
An increasing demand for services, coupled with comparatively lower pay and lower status of health professionals who specialize in long-term services, has made recruiting and retaining a long-term services workforce difficult. For example, geriatricians are paid less than other specialists. In addition, approximately 19 percent of health care aides and 16 percent of nursing home aides are not paid at a level sufficient for them to rise above the federal poverty level.
Informal caregivers, such as family members, help fill the gaps. The estimated 52 million Americans who provide informal care to a family member or friend are a vital element in our long-term services delivery system. However, providing such care can be a drain on caregiver finances and can result in reduced formal employment and lower wages. The typical working family caregiver loses approximately $110 per day in wages and health benefits due to caregiving responsibilities. This has a financial impact on caregivers, their families, and the communities in which they live. An expanded long-terms services workforce and better coverage for community-based care could help reduce the burden on caregivers.
Help in the Affordable Care Act. The Affordable Care Act, passed in March 2010, includes programs that are designed to help meet the growing demand for services by increasing the direct care workforce—the aides and personal attendants who care for people who need long-term services.
- Grant Programs. The Affordable Care Act establishes several demonstration programs that are designed to build the health care workforce. One program will award three-year grants to up to six states to develop training and certification programs for personal and home care aides.
- Better Workforce Planning. The Affordable Care Act establishes a framework for better health care workforce planning, including within the direct care workforce.
- The Comptroller General will appoint 15 members of a National Health Care Workforce Commission to serve as a national resource on health care workforce issues for federal, state, and local governments. The Commission will coordinate with the Departments of Health and Human Services (HHS), Labor, Homeland Security, Veterans Affairs, and Education. It will evaluate workforce needs, education, and training programs, and it will make policy recommendations to ensure that health care workforce needs are met.
- The Department of Health and Human Services will establish a National Center for Healthcare Workforce Analysis that will work with the National Health Care Workforce Commission to analyze workforce needs and evaluate programs.
- Training Opportunities for Direct-Care Workers. The Affordable Care Act includes several programs to expand education and training opportunities for direct care workers and others who work with seniors and people with disabilities.
- It establishes a grants program that will allow eligible educational institutions to provide tuition assistance to direct care workers enrolled in their academic programs.
- It expands programs within the Department of Health and Human Services that give grants to educational institutions to develop training programs that incorporate cultural competency and aptitude for working with people with disabilities. These programs will be designed to prepare direct care workers to better relate to and work with clients who have disabilities or who are from a cultural background different from the workers’ background.
- It expands existing grant programs for geriatric education centers.
These programs will help the United States better plan for its workforce needs by establishing education programs for direct care workers and offering loan forgiveness to encourage more people to enter the field. Taken together, the grant programs, incentives to enter the long-term care workforce, and the new approach to comprehensive workforce planning that was included in the Affordable Care Act should help us better meet the demand for long-term services workers and better support those who need care and their families.
The following organizations are resources on long-term services workforce issues: