Direct care workers are an essential part of the long-term care’s future. What types of federal interventions are needed to support workers and enable them to thrive moving forward? A new report suggests solutions.
Between 2019 and 2029, 7.4 million new jobs will be necessary to meet the growing demand for direct care workers in post-acute and long-term care (PALTC). Add to the that 6.9 million openings created by workers transferring to other occupations or leaving the workforce altogether, and a serious workforce crisis is brewing. With worker shortages already causing challenges across the county, a significant federal investment in this workforce is desperately needed. A new report from PHI International identifies several opportunities for the government to support direct care professionals and attract more workers to the field.
Among the report’s findings:
- Nearly half of direct care workers live near poverty and struggle to make ends meet. Federal leaders should improve economic security for these workers and help stabilize this job sector.
- The older population is growing rapidly and these individuals, as well as younger patients with disabilities, rely on direct care workers. However, poor job quality makes meeting the needs of patients difficult. Federal leaders should ensure that more individuals can access workers in the long-term care setting of their choice.
- Equities exist – both in opportunities and economics – for direct care workers, who have long dealt with these issues. Federal leaders should advance economic development by transforming these jobs. They also should address inequality, ensuring that women, people of color, and immigrants have greater access to opportunities.
- The COVID-19 pandemic has spotlighted the deep-rooted challenges facing the direct care workforce. Federal leaders should help us move out of this crisis and remain focused on sustainable workforce solutions.
The report also makes a number of recommendations:
- Reform long-term care financing to strengthen direct care jobs. This should including Medicaid reform, alternative financing models, Home and Community-Based Services Access Act access and workforce plans, and public investment in standards and value-based payments.
- Increase compensation for direct care workers. The entire long-term care system needs enough funding and reform to improve the economic wellbeing of essential workers. Congress should enact and fully fund the American Families Plan, which would expanded affordable childcare, universal preschool, expanded higher education access, individual and family tax credits, and comprehensive paid leave for millions of workers. Additionally, there needs to be a national compensation strategy, with the Centers for Medicare & Medicaid Services collaborating with other stakeholders to develop a national strategy.
- Strengthen training standards and delivery systems for direct care workers. This needs to include personal care aide training requirements, a strong training infrastructure, and a study on the national training infrastructure for direct care workers to identify gaps and best practices.
- Fund, implement, and evaluate direct care workforce interventions. Congress should enact and fully fund the Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act, which would invest more than $1 billion over five years in workforce interventions to improve training, recruitment, retention, and advancement opportunities.
- Improve direct care workforce data collection and monitoring. This should include developing workforce definitions and eligibility requirements, creating a data collection infrastructure, and developing and incorporating a core set of direct care workforce quality measures. The U.S. Department of Health and Human Services should develop a national direct care workforce strategy, convening a stakeholder advisory council to identify actions that government, providers, public-private sector organizations, philanthropy, and others can take to transform direct care jobs.
- Rectify structural and gender and racial inequities for direct care workers by creating a pathway to citizenship, immigration supports, research on immigrants and the grey market, workplace violence prevention efforts, LGBTQ protections, and more.
The authors concluded, “As demand for long-term care continues to grow exponentially in the years ahead, significant investment will be needed to effectively transform direct care jobs and improve care for all those who need it.” They further noted, “Federal leaders across the board can make this vision a reality by prioritizing direct care workers and investing in long-term care financing, compensation, training, workforce interventions, data collection, direct care worker leadership equity, and the public narrative.”