Caregivers and Quality in Long Term Care
Edward Salsberg, Ph.D.Executive DirectorCenter for Health Workforce StudiesSchool of Public HealthState University of New Yorkat Albany http://chws.albany.edu
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
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
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
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
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
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
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
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