Report highlights need to boost LTSS direct care workforce


Image by Enrique Bosquet via flickr.

Some states are considering social insurance programs to help offset the cost of long-term services and supports (LTSS) care for consumers.

In May, Washington state became the first state to enact legislation that helps finance LTSS for its residents. However, these programs must also strengthen the direct care workforce, according to a new report from PHI, a national research and consulting organization, and Caring Across Generations, a national caregiving advocacy organization.

The challenges and cost of long-term care keep increasing, with little help coming from the federal government. More states are considering other options to help offset costs. The National Academy of Social Insurance released a blueprint for states on structuring and financing LTSS programs, along with a universal family care state policy framework that includes paid family and medical leave.

“The heightened interest in creating social insurance programs to fund long-term care is both encouraging and much-needed — yet policymakers should ensure that these programs also transform the quality of direct care jobs so that consumers can access this care,” PHI President Jodi M. Sturgeon said in a statement.

The report outlines nine policy areas where state-based social insurance programs in LTSS can build up the direct care workforce. Among them: policy reforms that raise compensation, enhance training, promote advanced roles, and improve supervision in this sector. Other recommendations focus on:

  • Funding innovative recruitment and retention strategies;
  • Building stronger data collection systems;
  • Commissioning state-sanctioned workgroups dedicated to this workforce;
  • Launching efforts that enhance the relationship between family caregivers and direct care workers; and
  • Constructing matching service registries that effectively connect consumers with workers online.

Care cannot become more accessible or affordable unless we solve the crisis that direct care workers face every day, according to Josephine F. Kalipeni, director of policy and federal affairs at Caring Across Generations.

As policies such as universal family care take shape to help address the needs of an aging population, Kalipeni noted that they must also directly invest in and support the dignity of the people doing this important work. Approximately 4.3 million direct care workers — those who provide most of the paid, hands-on care for millions of older adults and people with disabilities — will be critical to the success of these policies, she said.

However, jobs in this sector frequently are characterized by low wages, minimal training, and limited career paths, among other challenges. PHI estimates that the direct care sector will need to fill 7.8 million jobs by 2026 — a need spurred in part by high turnover in this workforce. Even the government’s General Accounting Office (GAO) questions whether supply can keep up with demand.

According to the National Domestic Workers Alliance, a coalition of local groups seeking to improve standards for this workforce segment, many domestic workers do not earn a living wage and work without access to health care, paid sick days or paid time off. These struggles are often hidden from the public spotlight, because of the unique location — inside other peoples’ homes — where this work largely takes place. “Domestic workers take care of what is most important to us, yet they are often the least valued and the most vulnerable.”

Many of the Democratic presidential candidates have issued health policy proposals, but only a handful have discussed specific ideas about long-term care to date. Washington state’s plan could become a model for other states.

“I would like to see more discussion on how to make long-term care more affordable and accessible to families across the country. The high costs of long-term care impoverish too many older people and people with disabilities, and we need stronger solutions to prevent this from happening,” Robert Espinoza, PHI’s vice president of policy, said in an email. “We also would like to see an ambitious plan that strengthens the direct care workforce nationwide, raising compensation, improving training, and providing career opportunities, as three key reforms.”

Espinoza said the new report provides a “smart and sensible framework” for transforming this critical workforce.

Journalists reporting on direct care workforce issues in their state or community may want to crunch the numbers to see whether there are enough workers to care for today’s aging adults. What about future projections? Does your state have a plan?

These resources can help you get started:

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