Direct Care Workforce Crisis

In the United States, some 10 million people require assistance to manage the everyday activities of caring for themselves. About 60 percent are elders who have either cognitive or physical disabilities associated with aging; another 3.5 million are adults under the age of 65 living with chronic illnesses and disabilities. Finally, 400,000 children also need this kind of assistance.

Though the vast majority of long-term care is provided by family members, today many families are unable to provide their loved ones with daily support. When a family member is not available to provide this care, Americans rely on the 2.1 million direct-care workers who provide assistance with daily living, in people's homes, adult day care centers and group residences, assisted living facilities, and nursing homes.

Direct-care workers provide 80 percent of the paid, hands-on care delivered to long-term care consumers. As such, they play a critical role in ensuring that consumers receive high-quality care. In fact, most consumers report that the quality of their relationship with their paid caregiver is the most important factor contributing to their quality of life. Yet, as a society, we have put few resources into ensuring a competent, caring direct-care workforce.

As a result of poor wages, minimal training, poor supervision, and few opportunities for advancement, vast numbers of direct-care leave their jobs within the first few months of employment. Turnover rates in nursing homes often average over 70 percent per year. This kind of turnover compromises care, which is dependent on consistent, on-going relationships.

Instability plagues the direct-care workforce. But that is only one piece of a growing crisis. Over the next decade, the demand for direct-care workers is going to grow enormously, as our population ages and more people living with disabilities choose to live in the community. The U.S. Bureau of Labor Statistics, in fact, predicts that by 2010 we will need more than 780,000 new aides to fill long-term care staff positions. Yet, the number of new caregivers (women between the ages of 24-45), entering the civilian workforce during the same period is projected to grow by only 1.25 percent, an increase of only 400,000.

To address this growing "care gap," it is essential to improve the quality of direct-care jobs in order to attract and retain new caregivers. Today long-term care stakeholders, policymakers, and advocates like PHI are working together to create direct-care jobs that:

• Pay a living wage and provide adequate health coverage for workers and their families

• Provide quality, learner-centered entry-level and on-going training for workers to become competent and confident caregivers.

• Provide support through on-going supervision and access to supportive services when needed.

• Offer workers opportunities for personal and professional development and career advancement.

• Offer the opportunity to develop consistent, on-going relationships between caregivers and consumers.

PHI is working with long-term care stakeholders and policymakers across the country to transform what have been traditionally low-wage dead-end jobs into caregiving careers that offer fair wages, a supportive work environment, and career opportunties. A quality jobs strategy brings to each stakeholder group, guranteeing:

• For consumers: Uninterrupted access to care and services, provided by dependable, qualified caregivers, in a setting of the consumer's choice;

• For workers: A quality position as a caregiving professional; and

• For providers: Public policies and resources that support compassionate, client-centered care; effective workplace practices; and the ability to attract and retain an adequate base of skilled, direct-care.

Together, we can solve the direct-care workforce crisis and ensure a competent and stable workforce to provide the support and assistance our loved ones need now and in the future.