The Biden administration should use some of the $400 billion it wants to spend shoring up home- and community-based services on support systems for direct care workers, including the certified nurse aides vital to skilled nursing, a team of public health and geriatric researchers argued in Health Affairs Thursday.
Led by Sheryl Strasser at Georgia State University, the authors drew on their ongoing, nationwide survey of direct care workers (DCWs) to propose a three-pronged approach to sustainable career development and social support for such workers.
“The business of caring is costly — to the system, to clients, and to DCWs who have little to no incentive to stay in their job even though our economy and health care system relies heavily on DCWs,” they wrote. “Developing opportunities for growth within the direct care workforce is imperative for promoting the well-being of our professional caregivers, the clients and families they support, and the sustainability of our long-term care service system.”
The authors emphasized the loss of frontline workers in nursing homes as a factor that has contributed to an estimated 55% of skilled nursing facilities limiting admissions, per the American Health Care Association.
Strasser and her colleagues noted that more than four million direct care workers are currently employed across a range of caregiving roles, including in nursing homes, as home health aides and even as companions. The US will need eight million direct care workers in the next decade to meet demand for skilled nursing and home care services. But there will be a shortfall of 150,000 by 2030, hitting 355,000 by 2040, they wrote.
And there is little incentive for many current workers to stay; many also care for their own children or adult family members and as many as 10% of those who leave the profession do so because of such obligations.
“Administrators in our ongoing study have shared that their clients have a huge demand for these services, but the supply of DCWs is low — resulting in administrators spending months searching for caregivers to fill open positions,” they wrote. “DCWs are in high demand, subjected to long and demanding work hours and exhausting conditions with little opportunity for respite or time to foster their own well-being.”
DCWs also often see too little opportunity for professional growth.
The authors are recommending the administration establish workforce funds to be allotted specifically to home care agencies, long-term care facilities and other organizations to support direct care worker training.
They envision comprehensive pathways that acknowledge the career’s physically and emotionally challenging work. Strasser and team suggested adding caregiving coaches that support other care workers, as well as family caregivers in the community.
Another pathway could be to train direct care workers to develop their own caregiving organizations or specialize in the administration of relevant services and critical for worker well-being.
“With this investment in workforce training and development, new DCWs entering the workforce as well as current DCWs would have multiple options of career trajectories,” they wrote. “Their experiences and expertise learned on the job could directly prepare them for supporting other DCWs and family caregivers.”
