LTC Worker Shortage Can be Improved with Funding for Retention, Training, Advancement

Industry stakeholders and academic professionals are calling for better workforce development for direct care workers (DCWs) to address an unprecedented shortfall predicted in the coming decades.

The solutions – ranging from professional development and recruitment methods, retention and career advancement methods – were published in the journal Health Affairs, and are drawn from an ongoing mixed methods study involving a nationwide survey of DCWs and interviews with DCWs and home care executive directors.

“Administrators in our study worry that younger caregivers are not entering the caregiving workforce, resulting in older caregivers shouldering a disproportionate amount of physically and mentally demanding caregiving responsibilities,” researchers wrote. “Consequently, the rate of attrition is likely to increase, with risks to the sustainability of long-term care services.”

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The U.S. needs nearly eight million DCWs in the next decade to meet demand for home care and nursing services, but projections indicate a shortfall of more than 150,000 DCWs by 2030 and 355,000 by 2040, researchers noted.

Researchers suggest specific policy recommendations, including ways to allocate the $400 billion investment towards home and community-based services included in the Biden administration’s Build Back Better Plan.

A portion of the funds should be designated for home care agencies, school districts, and long-term care facilities to invest in community-based services, researchers said.

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“When these organizations receive grants, they can use these funds to train DCWs (for example, students) to provide specialized support to other DCWs and family caregivers in different ways,” researchers wrote.

Researchers also suggested that training DCWs as caregiving coaches to support other DCWs within their organization as well as family caregivers in their local or cultural community could help with retention, and that investing in DCW career advancement could also generate revenue for home care agencies and skilled nursing facilities.

“For instance, a home care agency could invest in training a DCW to become a caregiving coach, who could then offer ongoing support (for example, bereavement support) to fellow DCWs,” researchers wrote. “This model could contribute to lower turnover and a sustainable direct care workforce.”

Lastly, researchers noted that increasing Medicaid reimbursements for home health care could leverage increased wages for DCWs.

“These reimbursements could be increased through wage increases, supplemental payments to home care agencies or nursing facilities based on quality metrics, or staff retention,” researchers wrote.