Caregivers and Quality in Long Term Care

1. Caregivers and Quality in Long Term Care Edward Salsberg, Ph.D. Executive Director Center for Health Workforce Studies School of Public Health State University of New York at Albany http://chws.albany.edu

2. The Health Workforce Crisis • Serious shortages threatening ability to deliver services • The squeeze -- few new dollars and the high cost of more workers • Concerns with medical errors and quality • Worker and management dissatisfaction • Buried in paperwork and regulation • Racial and ethnic imbalances • Decreased interest in health careers • Lack of systematic data on workforce needs

3. Factors Contributing to Health Workforce Shortages • Short term factors • Educational system response lags • Rising demand • Increasing case mix complexity • Long Term factors • The aging of America: increasing demand and decreasing supply of workers • Increasing demand due to increasing income, expanding interventions, and increased survival of individuals with chronic illness • Changing racial/ethnic mix • Expanded career choices for women

4. Factors Contributing to Health Workforce Shortages, continued • Workplace factors • Physically and emotionally demanding work • Non-competitive wages and benefits • Job design and working conditions • Paperwork and lack of information systems • Poorly trained managers

5. Employment in Health Care Is Expected to Grow Rapidly in Coming Years • The Bureau of Labor Statistics (BLS) forecasts that employment in all health care occupations will grow by 29% between 2000 and 2010, twice as fast as the rest of the economy. • Total job openings due to growth and replacements between 2000 and 2010 are forecast to be: • Registered Nurses 1,004,000 • Nurse Aides, Orderlies, Attendants 498,000 • Home Health Aides 370,000 • Personal and Home Care Aides 322,000 • Licensed Practical Nurses 322,000 Bureau of Labor Statistics: Occupational Employment Projections to 2010, Monthly Labor Review, Nov 2001

6. Direct Care Workers Comprise the Majority of Workers in Long Term Care • Home Health Care Workforce • 50% Home health aides and other aides • 19% RNs • 6% LPNs • Nursing Home Workforce • 38% CNAs and other aides • 11% LPNs • 9% RNs

7. Long Term Care Aide Shortages:A. The Worker Perspective • Low wages and benefits (Certified Nurse Aide: $9.22 per hour; Home Health Aide: $8.38 per hour) • Alternative jobs • Poor working conditions • Difficult jobs – physically/mentally demanding • Lack of career opportunities: dead end jobs • Lack of recognition or status • Poor treatment • Gap between training and real job demands

8. Long Term Care Aide Shortages:B.The Provider Perspective • Too little reimbursement • State and federal regulations and oversight • Poorly prepared workers • High turnover • Low unemployment rate • Increasing patient acuity • Growth in total number of jobs

9. State Government Roles Related to the Health Workforce • Licensure and regulation of health professionals • Regulation of health facilities • Regulation of educational programs • State colleges and universities • Medicaid reimbursement policies and regulation of private insurance • Labor Department training programs and employment data collection • Employer in state facilities and agencies • Health workforce data collection