The Current State of the Eldercare Workforce

Recognizing that recruiting, training, and retaining quality staff in long-term and post-acute care is a perennial challenge for providers, the Advancing Excellence in Long-Term Care Collaborative (AELTCC) decided to focus on the topic of workforce for its Winter Forum. The group, which met in February in Washington, D.C., invited three experts who addressed the following topics: the rise of acuity and complexity, a workforce that continues to age, and turnover rates that remain high.

Selected for the panel were three individuals representing direct care workers, family caregivers, and aging services technology. The panel’s first presenter, Amy York, executive director of the Eldercare Workforce Alliance (EWI), offered some sobering statistics about healthcare workers, nearly all of whom provide some degree of care to older adults , but almost none have the training to do so. Following are some facts supporting York’s assertion:

• Less than one percent of all registered nurses are certified as gerontological nurses.
• Only four percent of psychologists are trained to work as specialists with older adults (i.e., geropsychologists).
• Less than half of pharmacy schools have a distinct course in geriatrics despite the fact that per capita prescription drug use by people 65 and older is triple that of younger individuals.
• 20,000 geriatricians are needed now to care for more than 14 million older Americans.

In addition, York noted that immigrants comprise a significant part of the U.S. direct care workforce, totaling 860,000 people, and roughly one in four direct care workers is an immigrant. What’s more, one in three immigrants has lived in the United States for [S1] at least 25 years.

York’s recommendations for addressing these issues? Establish coordinated team care with social supports; train and support larger workforce and family caregivers; and recognize the importance of the direct care workforce.

Panelist number two was Lynn Friss Feinberg, MSW, senior strategic policy advisor for the AARP Public Policy Institute, who conveyed four main messages regarding family caregivers:

• Serious illness and chronic disability affect the family as well as the individual.
• Family caregiving today is more complicated, costly, stressful, and demanding than at any time in human history.
• The United States is facing an unprecedented care gap.
• It’s time to treat family caregiving with a new urgency and make it a federal, state, and local priority.

Friss Feinberg noted that an estimated 46 percent of family caregivers do medical/nursing tasks, while they spend an average of 20 percent of their income on caregiving activities. In addition to monetary costs, family caregiving causes substantial physical, emotional, and social costs to the caregiver and other family members.

In response to the plethora of challenges that family caregiving bring, AARP developed model legislation known as the Caregiver, Advise, Record and Enable (CARE) Act. The CARE Act instructs hospitals to identify a family caregiver for inpatient admissions and record the family caregiver in the medical record; notify the family caregiver of discharge plans for the person in the hospital; and offer family caregivers training on medical/nursing tasks they may be asked to perform at home. CARE Acts have now passed in 39 states and territories.

Majd Alwan, PhD, is executive director of the Center for Aging Services Technology (CAST), an organization committed to expediting the development, evaluation, and adoption of emerging technologies that can improve the aging experience. Alwan provided an overview of technology that is helping long-term and post-acute care providers make timely decisions via electronic documentation such as electronic health records that can be deployed in a variety of ways, from tablets and handheld devices to kiosks and voice documentation.

Following are some of CAST’s recommendations for tackling workforce:

• Include technology in our strategies to attract, engage, and retain staff, especially millennials.
• Adopt technology and best practices, including training practices discussed.
• Adopt appropriate policies and procedures, like Bring Your Own Device (BYOD), when appropriate.
• Showcase technology and efficiency tools, including mobile apps, in job fairs, recruitment ads/campaigns, and job postings.
• Encourage Technology Ambassadors, at all levels, to also be recruitment ambassadors.

Following the panel presentations, the bulk of the discussion centered on the opportunities presented by technology as well as the challenge it presents. Among the topics was the implementation of technology and how to engage staff in the process, especially frontline staff.

Others raised concerns about attracting millennials, the availability of career ladders and lattices, and the presence of vocational tech programs in high school for certified nursing assistant (can) and other direct care positions. Concerns about how to raise low wages and paltry benefits also was discussed.

The group identified some items that the AELTCC board may consider tackling, but also engaged in a robust discussion about whether the items support the mission of the collaborative.

The topic of ageism came up as an explanation for why there are not enough younger people interested in careers in aging services.

Although a concrete action plan was not created, the group was eager to continue the discussion and possibly take on a task that could help to elevate the issue at both the national and state level.