Nursing homes more likely to send Medicaid recipients to hospital, study says

Low wages and a lack of respect for direct care workers are putting the long-term care industry on a dangerous path to worker shortages, a professor warned last week.

“It’s an absolute train wreck waiting to happen,” Paul Osterman, Ph.D., a professor of human resources and management at the Massachusetts Institute of Technology, told Reuters.

There will be a national shortage of 151,000 paid direct care workers and 3.8 million unpaid family caregivers by 2030, he said. That’s expected to increase consistently, with an estimated gap of 355,000 paid workers by 2040.

“These are conservative estimates,” said Osterman. “They assume no changes in immigration policies, and that family members will be willing to provide care at the same rate they do today – that’s not likely, due to smaller families and more geographic dispersion.”

In 2015, 18% of CNAs and 27% of home care aides were immigrants. The long-term care industry has supported legislation that would, for example, waive a cap on employment-based visas for overseas nurses and physical therapists, or open up opportunities for semi-skilled workers, such as RNs, to fill open slots. The long-term care industry is expected to need four million new workers by 2050, according to American Health Care Association estimates.

Osterman says part of the challenge is low caregiver wages. The median income in 2015 was $20,000 for a CNA and $15,000 for a home care aide, according to U.S. Census tracking.

“It’s difficult for wages to rise because they are set bureaucratically according to Medicaid reimbursement rates,” Osterman said. In long-term care, two-thirds of care is funded through Medicaid.

Among his suggestions for attracting new applicants to the workforce include creating a better culture of respect for direct care workers and restructuring the role of caregivers to potentially add responsibilities, as well as offer opportunities for advancement.