Crisis in Workforce Supply—Read All About It!

This is one of a series of articles presenting information resources relevant to long-term care issues. Emphasis is placed on sources that might not show up in a typical journal search.

It’s widely asserted that there is a crisis, or at least an impending crisis, in the workforce supply for aged long-term care. There are not or soon will not be enough well-trained workers to meet the expanding needs. The national social policy spotlight has clearly highlighted this issue. The U.S. Congress, federal, and state agencies have studied and reported on it. Presented here are some reports available from the Internet that provide key data and provide a footing for understanding and planning.

TERMINOLOGY

We found the following terminology summary to be most useful. These words are used interchangeably: paraprofessional workers, direct care workers, and frontline workers, and they “refer to nurse aides or assistants, personal care aides or assistants, home health aides, home care aides, and others who provide paid hands-on assistance with bathing, eating, dressing, and other activities of daily living for persons with disabilities.”¹

HRSA’S “MUST HAVE” REPORT

This premier study concludes “that informed workforce planning is needed . . .[to document shortages and] to assess the impact of . . . initiatives to balance supply and demand.”² This predictable and low-key assertion undervalues the report, which, in fact, presents an extensive review with powerful implications. The report was commissioned by the National Center for Health Workforce Analyses, Bureau of Health Professions in the Health Resources and Services Administration (HRSA). It documents the “shortage of long-term care paraprofessionals and [affirms] that the shortage is likely to be far more severe in the future.” It is chock full of data. In the near term, 1.2 million additional nursing and home health aides will be needed by 2010. “The pool, however, from which such workers have traditionally been drawn—largely women between 25 and 50…continues to shrink.”

The problem will only get worse by 2030 as baby boomers reach their mid-80s, when demand for assistive care explodes. About four times as many recipients of long-term care reside in the home or community than in nursing homes. The report includes an annotated bibliography. But above all, the report makes a compelling case for improving data collection. It’s a long report, close to 200 pages, but should be on the desk of anyone interested in workforce supply for care of the aged.

CONGRESSIONAL REPORT

Congress requested that the Departments of Labor (DOL) and Health and Human Services (DHHS) identify the causes of the shortage of paraprofessionals working in long-term care. Their response, a Report to Congress in 2003, provided estimates from the DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the DOL Bureau of Labor Statistics. “These (estimates) indicate that it is critical to retain existing long-term care workers and attract new ones,” they concluded.³

Specific recommendations included: “Dialogue with Employers”; work with faith and community-based organizations; provide more technology for recruitment and training; and try to recruit older workers and other nontraditional sources of workers. The report also called for continued research support. The report is a good source for labor supply data.

NON-PAID PROVIDERS

Not all personal care is provided by paid paraprofessionals. Much comes from informal caregivers. If you ever want to describe the typical informal caregiver, she is 46 years old, “has at least some college experience and provides more than 20 hours of care each week.”⁴ These and other descriptive data were collected and presented by the National Alliance for Caregiving and AARP. “Caregiver” here is an adult person who cares for an adult family member or friend. Most of the time (83%), it is a relative. While the “typical” caregiver is female, about 40% are male. Male caregivers are more likely to be working full-time (66% vs 55%). An astounding 21% of adult Americans provide unpaid care to adult friends or relatives; 16% of adult Americans provide such care to people age 50 or older.

TYPICAL DIRECT CARE WORKER

If you ever want to describe the typical paid direct care worker, she is a single mother aged 25-54. Compared to other jobs, she is more likely to be nonwhite. Only 10-20% of direct care workers are male. Home care aides tend to be older than aides in other settings, and less likely to be native-born U.S. citizens.¹

WAGES

How much do direct care workers get paid? About $6 an hour for home care aides, $7 for nursing home aides, and $8 for hospital aides (adjusted to 1998 dollars), according to a recent Research Synthesis (May, 2004).¹ Written by the Institute for the Future of Aging Services, the synthesis examines trends, factors influencing supply and turnover, and initiatives that may address the direct care crisis. The report was sponsored by ASPE. Another source gives wages in 2003 dollars. Wages for hospital aides were $9.85, home health aides $8.77, and home care aides $7.91.⁵

WEBSITES

Some websites are of interest, as well. The National Clearinghouse on the Direct Care Workforce provides a free two-page Fact Sheet describing the direct care worker.⁶ It also provides policy-relevant news and many pertinent links.

The nonprofit Paraprofessional Healthcare Institute provides downloads or links to many papers and reports, including state policy reports from Michigan, Massachusetts, Pennsylvania, and New Hampshire.⁷ The website also provides information about possible recruitment, retention, and quality improvement actions.