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Congress Must Address the Long-Term Care Workforce | Commentary

On December 18, Congress takes up one of the most difficult challenges facing our nation: how to provide quality long-term services and supports to older adults and people living with disabilities. The Senate Special Committee on Aging is holding a hearing on the recommendations made by the federal Commission on Long-Term Care, a panel of experts appointed earlier this year to examine the barriers to providing affordable, quality care to millions of Americans who need daily assistance with activities such as bathing, dressing, toileting and preparing meals.

This workforce, which is the mainstay of the long-term care delivery system, is all-too-often ignored by policymakers. This time, however, direct-care workers — home health aides, personal care aides, and certified nursing assistants — feature prominently in the Commission’s recommendations. It is our hope that the Senate Special Committee on Aging will carefully consider these recommendations for future Congressional action.

Direct-care workers provide 70 to 80 percent of the paid hands-on care associated with long-term services and supports. As our population ages, demand for these workers is growing astronomically. By 2020, demand is projected to reach 5 million workers: more than the number of nurses needed for the entire health care system or the number of K-12 teachers needed to educate our youth. Meeting this growing demand will require significant improvements to direct-care jobs. In the absence of raising the floor of these critical jobs, we cannot be assured that sufficient numbers of workers will be willing to work in this field.

The fact is, though caregiving jobs can be rewarding, the work is incredibly hard. It takes patience, enormous fortitude, superb interpersonal skills, and physical strength to help maintain the dignity, health and wellness of our nation’s elders and those living with disabilities.

On top of the day-to-day challenges of the work itself, wages are low, employment benefits are rare, part-time hours are common, and injuries are rampant. Recently, nursing aide was named the most dangerous job in America. These workers miss more days of work due to injuries—often back and muscle strains—than workers in any other occupation, even construction workers.

Direct-care work is undervalued and underpaid, in large part because these jobs are considered “low skill” and are performed primarily by a female workforce, more than half of whom are women of color. But ask any individual who needs personal care services — or their family members — and you are likely to find that the most valued person on the care team is the aide. The direct-care worker has daily, hands-on interaction with the individual receiving services enabling her to notice and communicate subtle changes in a person’s condition to other members of the team. Working with the individual and family caregivers, she has the skill and compassion to help ensure that the person she cares for lives with dignity and respect.

We cannot build the stable, skilled direct-care workforce we need to deliver affordable, high quality care without federal policies that make these jobs competitive. As my organization, the Paraprofessional Healthcare Institute, has advocated for decades, quality care absolutely requires quality jobs.

Of particular concern is the strengthening of the home care workforce, since most Americans want to age in place, with care services provided in their homes and communities. Unless we take action, baby boomers will find themselves without this option when they can no longer care for themselves.

Fortunately, the Commission on Long-Term Care’s majority and minority reports included a number of recommendations that Congress should get behind to build a 21st-century, direct-care workforce: better training and opportunities for career advancement; rate setting policies that guarantee wages sufficient to attract committed workers and reduce turnover; integration of direct-care workers into care teams; and improved data collection to inform policy decisions.

Every day, 10,000 baby boomers turn 65. Today, 12 million Americans need long-term services and supports; by 2050 that number will have more than doubled, to 27 million. Congress must take steps now to prepare our nation for this potential crisis. Taking up the Long Term Care Commission’s excellent workforce recommendations is a good place to start.

Jodi M. Sturgeon is president of the Paraprofessional Healthcare Institute, headquartered in New York.

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