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Long-Term Care Workforce Crisis

Long-term care, or LTC, is “…the care you may need if you are unable to perform daily activities on your own. That means things like eating, bathing, dressing, transferring and using the bathroom,” (Genworth.com). LTC includes both medical and non-medical support, and is provided to anyone in need, not just the 65+ population. The long-term care workforce includes nursing assistants, home health and home care aides, personal care workers, and personal care attendants (Institute for the Future of Aging Services). However, physicians, nurses, administrative staff, and informal caregivers are also included in this workforce (Leadingage.org).

With the increasing presence of aging baby boomers and a retiring workforce, “The US will need to hire 2.3 million new health care workers by 2025 in order to adequately take care of its aging population, a new report finds,” says CNN. While this may speak of the healthcare workforce shortage as a whole, the long term care workforce shortage is a large part of the overall picture. According to this article by CNN, home health aides, which are a large component of the long-term care workforce, are projected to suffer the highest shortage rate of all healthcare professions by 2025. They were projected to be short nearly 450,000 workers, according to the article. In addition, their shortage far exceeds the other three professions listed in the study. The next highest, with a projected shortage number of 98,700, are medical and lab technicians and technologists. They are followed closely by nursing assistants, (who are also primary workers in the long-term care workforce), with a projected shortage of 95,000 workers. At 29,400, nurse practitioners come in last of the top four healthcare workforce shortage projections.

There are a number of factors contributing to the LTC workforce shortage. Low wages are a considerable contributing factor. Home health aides make up one of the larger portions of the LTC workforce and, according to Salary.com, they make an average of $12 an hour in the United States as of October 2019. Combine this with the fact that the job itself is strenuous and taxing, recruiting and retaining workers in this field is extremely challenging.  According to this LTC workforce commission report by the Institute for the Future of Aging Services, there are more occurrences of accidents and injuries in LTC than are found in the construction and mining industries. The report also adds, “ One national study of assisted living reported annual turnover rates of about 40 percent among personal care workers and nurse aides.” In addition to poor wages, job dissatisfaction contributes to the high turnover rates in this field. However, one of the top, if not the top reasons direct care paraprofessional workers don’t leave their jobs is due to their relationships that are formed between them and the older adults under their care. Amongst these workers, those who feel that their supervisors appreciate them and take the time to listen to them are more likely to stay in their position, the report shares.

There are numerous other reasons why recruiting and retaining workers into LTC is challenging. One reason, according to the report, is the negative stigma that surrounds nursing homes. Poor human resource practices are also a large complaint made by workers in LTC.  Many direct care staff feel their supervisors and managers aren’t adequately communicating with them or listening to their needs. Many feel “powerless to change their work environment.”  Furthermore, the report discusses the lack of education and training, saying, “Most direct care paraprofessionals appear to learn what is expected of them and how to do their jobs after they have been hired. As a result, large numbers are unprepared for the demands placed upon them and leave their jobs within the first few months.”  The disconnect between the training for the job and the job itself falls on the responsibility of both the employer and the training provider. This isn’t to say that recruitment campaigns must highlight every negative aspect of LTC work in order to set realistic expectations for incoming workers; rather, the onboarding process and subsequent training must realistically reflect the expectations and roles of the job so that new employees feel prepared and competent.

The report also shares an unsettling explanation for why paraprofessionals are more difficult to recruit and retain in the LTC workforce. They say:

The dilemmas peculiar to the recruitment and retention of the paraprofessional workforce are perhaps the most complex and difficult to resolve. Wages are not adequate to support young families with children. The job is often not well-designed, creating inefficiencies, unnecessary job burdens and subjecting occupants to high rates of injury. There are few opportunities for career advancement. Supervision is poor or non-existent. In addition, low unemployment rates for all entry-level personnel, coupled with increasing levels of education among minority populations, provide this labor pool with far more choices than low-income women have had in the past.

There are clearly barriers on nearly every level that are prohibiting job satisfaction. With complex, multi-faceted problems such as this calls for various specialized and innovative solutions.  There are many avenues to take in order to attempt to solve the numerous complex issues surrounding the LTC workforce crisis. The LTC workforce commission report suggests a few:

  • Modernize the image of the long-term care industry
  • Target information on long-term care careers to post-secondary education and professional schools
  • Develop effective long-term care leaders and managers
  • Invest in information technology to reduce paperwork burdens in long-term care settings
  • Promote long-term care employers’ self-assessment of working conditions
  • Improve federal fair labor standards/other mandated worker protections for long-term care personnel
  • Develop pathways to career advancement in facility-based and home and community care settings
  • Establish “Center(s) on long-term care leadership, management and supervisory innovation”
  • Make education and training opportunities more accessible, particularly in rural areas
  • Improve medical directors’ performance

The solutions suggested in the report are not all listed here due to the large quantity of them. However, it is clear that there are many ways to help solve the LTC workforce crisis. Luckily, many healthcare workforce development initiatives have joined in the effort to implement many of these solutions. Health WorkForce New York is a non-profit organization dedicated to improving access to healthcare in under-represented and underserved areas across New York State and beyond. If you are interested in advancing your LTC services, contact us today to see how we can help.


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