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New Report Highlights the Direct Care Workforce in State-Based LTSS Social Insurance Programs

July 30, 2019

NEW YORK — As states increasingly consider state-based social insurance programs to help offset the cost of long-term care for consumers, they should ensure that these programs also strengthen the direct care workforce, argues a new report from PHI and Caring Across Generations.

A growing number of states are beginning to consider social insurance programs that would help consumers and their families afford long-term services and supports (LTSS).

In May of this year, Washington State became the first state to enact legislation that helps finance LTSS for its residents, and a month later, the National Academy of Social Insurance released a blueprint for states to structure and finance these programs in LTSS, along with “universal family care” state policy frameworks for social insurance programs focused on childcare and paid family and medical leave.

“The heightened interest in creating social insurance programs to fund long-term care is both encouraging and much-needed—yet policymakers should ensure that these programs also transform the quality of direct care jobs so that consumers can access this care,” said Jodi M. Sturgeon, president of PHI, a national research and consulting organization focused on the direct care workforce.

The report from PHI and Caring Across Generations–Workforce Matters: The Direct Care Workforce and State-Based LTSS Social Insurance Programs—outlines a framework made up of nine policy areas where state-based social insurance programs in LTSS can build up the direct care workforce.

The report calls for policy reforms that raise compensation, enhance training, promote advanced roles, and improve supervision in this sector.

The other five recommendations focus on: funding innovative recruitment and retention strategies; building stronger data collection systems; commissioning state-sanctioned workgroups dedicated to this workforce; launching efforts that optimize the relationship between family caregivers and direct care workers; and constructing matching service registries that effectively connect consumers with workers online.

“We cannot make care more accessible or affordable without solving for the crisis that direct care workers face every day,” said Josephine F. Kalipeni, director of policy and federal affairs at Caring Across Generations.

Kalipeni added, “As transformative policy solutions like Universal Family Care emerge, and states design and implement programs to urgently meet the care needs of an aging population, they must directly invest in and support the dignity of the people doing this vital work.”

Direct care workers–4.3 million workers who are the paid front line of long-term care–will be critical to the success of these new social insurance programs.

Unfortunately, jobs in this sector are too often characterized by low compensation, minimal training, and limited career paths, among other challenges. In January 2019, PHI estimated 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.

“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. The surge in states exploring social insurance options is a step in the right direction,” said Robert Espinoza, vice president of policy at PHI and the author of Workforce Matters.

Read the full report here.


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