This article first appeared in Forbes on July 30, 2019. Read the original there.
Between 2015 and 2050 there is projected to be a 208% population growth among people over the age of 85, while only a 12% projected population growth for those under 65 according to the National Academy of Social Insurance. And the U.S. Census Bureau asserts that by 2035 older adults will outnumber children for the first time in American history. What this means is that the United States is getting old, fast.
It further signifies drastic shifts in family dynamics, health and care demands, and the labor force. This is especially true as it impacts the long-term care needs and financial security of individual families throughout the U.S. “Our country is at a tipping point regarding long-term care – we need to make this system more affordable to families, and we need to boost workforce capacity to make it more accessible,” says Robert Espinoza, vice president of policy at PHI and the author of Workforce Matters.
So who is going to care for our aging population? And further, who is going to pay for it?
In a just released report, PHI and Caring Across Generations address how states that are exploring long-term care shortages and Universal Family Care programs might meet the challenges of workforce issues head on.
The State of Things
Over the last few decades, population trends, family living situations, and individual autonomy have greatly shifted. But many policies, payment structures, and workforce trends have not. For example, as more families rely on all working-age members of the family to work outside the home there is a lack of stay-at-home family care givers.
Subsequently, long-term services and supports (LTSS) in the home are needed at an exponentially growing rate, but many in-home senior care caregivers earn less than $17,000 a year. Thus, the line of work isn’t going to attract or maintain anywhere near enough workers to meet demand – or need. And turnover rates are going to exacerbate the gaps and continuity of care that already exist. In fact, in January 2019, PHI concluded that, “The direct care sector will need to fill 7.8 million jobs by 2026, a need spurred in part by high turnover in this workforce.”
Further, countless federal programs (many of which are patchwork in nature) were created with an aging population in mind, but designed well before current levels of poor health and long-term care demands. Consequently, it’s time to consider alternatives to the status quo. But at what cost to the general populace?
Ideas For The States
Given the evolving dynamics of our population and long-term health needs, the report focuses on resources, financing, and political feasibility of a path forward to transform direct care in the U.S. But it also lists nine distinct recommendations for states to consider as they impact the long-term caregiving workforce. Those recommendations are as follows:
1. Wages and Benefits – Increase compensation for direct care workers by establishing a wage floor to attract new talent. Additionally, establish benefit and financial security safeguards.
2. Training – Enhance training requirements and boost the in-person and online training infrastructure for direct care workers.
3. Advanced Roles – Develop advanced roles for direct care workers that allow them to progress in their careers. If offered a higher level of support this could increase retention.
4. Supervision – Institute supervision training programs and requirements
to successfully develop direct care supervisors and leaders.
5. Recruitment and Retention – Establish an innovation fund and state-level advocate to take ownership over the sector. This could lead to improved recruitment and retention among the direct care workforce.
6. Data Collection – Build a robust data collection system, as well as produce new research to analyze the direct care workforce at the state and local levels.
7. Decision-Making – Create a long-term, state-sanctioned workgroup and leadership program to strengthen the contributions of that direct care workers can make for themselves.
8. Family Caregivers – Launch demonstration projects and a policy workgroup to maximize the relationship between family caregivers and direct care workers. These interactions and shared commitments can improve retention.
9. Matching Service Registries – Construct a matching service registry that connects home care consumers and workers within a state.
No matter which, or all, of the recommendations state leaders wish to explore, it is clear that time is of the essence. Our aging population can’t wait. And neither can their care givers.