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Congress Must Heed Essential Workforce Recommendations of Long-Term Care Commission

December 18, 2013

— Senate Special Committee on Aging to Address Commission on Long-Term Care's Recommendations Today —

Today, the Senate Special Committee on Aging will hold a hearing entitled "The Future of Long-Term Care Policy: Continuing the Conversation," to discuss the recommendations made this fall by the federal Commission on Long-Term Care — including several recommendations for building and strengthening the direct-care workforce.

The Commission on Long-Term Care was appointed in March to examine the barriers to providing affordable, quality care to the millions of Americans who need daily assistance with activities such as bathing, dressing, toileting, and preparing meals. One of the key issues the Commission addressed in its Report to Congress (pdf) is how to build a skilled, stable workforce to support aging Americans. It is our hope that the Senate Aging Committee will carefully consider these workforce recommendations for future Congressional action.

Direct-care workers — home health aides, personal care aides, and nurse aides — provide 70-80 percent of the hands-on long-term care in a range of settings such as the home, nursing homes, and residential facilities.

As our population ages, demand for direct-care 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. Without them, 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.

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.

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. Quality care absolutely requires quality jobs.

Of particular concern is strengthening 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 the options they expect when they can no longer care for themselves. The Commission on Long-Term Care's majority and minority reports included the following recommendations that Congress should get behind to build a 21st century direct-care workforce:

  1. Establish rate-setting policies for public programs that guarantee wages in all settings that are sufficient to attract qualified, committed workers and reduce constant turnover.
  2. Establish minimum training standards for personal care aides to ensure that workers have the skills needed to deliver quality care. Reimburse training costs for all direct-care workers.
  3. Integrate direct-care workers into care teams so they can share their intimate knowledge of their clients' health and well-being and improve care coordination.
  4. Improve opportunities for advancement by revising scope-of-practice standards and creating career ladders that provide opportunities for professional growth.
  5. Strengthen infrastructure such as matching registries that make it easier for consumers to locate qualified and compatible workers.
  6. Strengthen workforce data collection in order to track the stability and growth of the long-term services and supports workforce and make informed 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 to care. Taking up the Long Term Care Commission's excellent workforce recommendations is a good place to start.

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PHI, the Paraprofessional Healthcare Institute, works to transform eldercare and disability services, fostering dignity, respect, and independence — for all who receive care, and all who provide it. The nation's leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality care.

Deane Beebe, PHI Media Relations Director

718-928-2033; 646-285-1039 (cell)

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