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Staffing in Long-Term Care Is a National Crisis

By Kezia Scales, PhD (she/her) | June 8, 2018

Editor’s Note: This excerpt is from Growing a Strong Direct Care Workforce: A Recruitment and Retention Guide for Employers.

Staffing challenges are not entirely unique to your organization—they are shaped by trends affecting long-term care employers across the country.

America is growing older.

From 2016 to 2060, the number of adults aged 65 and older will nearly double from 49 to 95 million. This means that one in four Americans will be at least 65 years old by 2060.

The labor force is not keeping up.

During the same time period, the number of adults aged 18 to 64 will only increase by 14 percent.

The need for long-term care is widespread.

Among those currently reaching retirement age, more than half (52 percent) will require long-term services at some point, and for an average of two years.

Did you know? The estimated direct cost of replacing a nursing assistant or home care worker is $2,200.[1]

Home care services are in particular demand.

Due to consumer preference and policy shifts, more and more people are receiving long-term care at home. As a result, home care is predicted to add over one million new jobs between 2016 and 2026.

Direct care jobs struggle to compete.

Especially in a stronger economy, many workers move to other industries that offer better job quality, whether higher wages, more stable hours, safer working conditions, opportunities for advancement, or other advantages.

Instability is common in this workforce.

Conservative estimates of turnover across the long-term care sector range from 45 to at least 66 percent. One in 4 nursing assistants and 1 in 5 home health aides report that they are actively looking for another job.

How can the field respond? Read our new guide, where you can also find a list of citations.


  1. Source: Adapted from Boushey, Heather and Sara Jane Glynn. 2012. There Are Significant Business Costs to Replacing Employees. Washington, DC: Center for American Progress. CostofTurnover0815.pdf.
Kezia Scales, PhD (she/her)
About The Author

Kezia Scales, PhD (she/her)

Vice President of Research & Evaluation
Kezia Scales leads PHI’s strategy for building the evidence base on state and national policies and workforce interventions that improve direct care jobs, elevate this essential workforce, and strengthen care processes and outcomes.

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

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