Jean Moore, M.S.N.
University of Albany
THE CENTER FOR HEALTH WORKFORCE STUDIES AT THE UNIVERSITY AT ALBANY
- Conducts studies of the supply, demand, use and education of the health workforce.
- Committed to collecting and analyzing data to understand workforce dynamics and trends.
- Goal to inform public policies, the health and education sectors and the public.
- One of six regional centers with a cooperative agreement with HRSA/Bureau of Health Professions.
OVERVIEW OF PRESENTATION
- Background on the health workforce.
- Implications of the aging of America on the health care system and its workers.
- Long-term care paraprofessionals: what we know and what we don’t know.
- Next steps.
CURRENT HEALTH WORKFORCE ISSUES
- Health worker shortages.
- The squeeze--few new dollars and the high cost of more workers--limit response options.
- Concerns with medical errors and quality.
- Worker and management dissatisfaction.
- Frustration with paperwork and regulation.
- Racial and ethnic imbalances in professions.
- Lack of systematic data on supply and demand for health workers.
FACTORS CONTRIBUTING TO HEALTH WORKFORCE SHORTAGES
- Short-term Factors:
- Competition for workers and the economy.
- Growing demand.
- Increased intensity and complexity of services.
- Educational system cycles and response lags.
- Long-Term Factors:
- Changing racial/ethnic mix in the US.
- Expanded career choices for women.
- The economy and public expectations.
- Increases in credential requirements.
- The aging of America: increase in demand.
- The aging of America: decrease in supply of workers.
A STUDY OF THE IMPACT OF AGING ON THE HEALTH WORKFORCE IN THE US
Recently completed study funded by HRSA
- Aging: Demographics, Models of Care, Family Caregivers, Technology, Reimbursement
- Profile of the Current Workforce:
- Over 20 health professions.
- Services to the elderly.
- Training, education, credentials related to aging.
- Supply trends/demand projects and gap.
- Profession-specific issues.
THE GROWING ELDERLY POPULATION WILL HAVE A SMALL POOL OF POTENTIAL FAMILY CAREGIVERS
- Compared to the current elderly, the growing cohort of aging Americans:
- Have had fewer children than their parents.
- Are more likely to be divorced.
- Are more likely to live alone as they enter old age.
IMPACT ON HEALTH SERVICES DELIVERY SYSTEM
- The elderly consumer more health care services than younger age groups.
- The elderly have different health care needs than younger age groups.
- The elderly will have a greater range of health care models to choose from than in the past.
- Access to care will be a greater issue for the elderly.
IMPACT OF THE AGING OF AMERICA ON THE HEALTH WORKFORCE
- Many health professions and occupations do not offer formal credentials focused on the needs of the elderly.
- When such a credential is offered, the number of workers with the credential is typically very small.
- A majority of health care workers in most settings deal with substantial numbers of elderly people whether or not they are specialists.
- Demand for health care professionals to serve the elderly will be affected by:
- Medicare reimbursement policies.
- New technologies.
- New models of care.
- Changes in profession-specific scope of practice focused on the needs of the elderly.
LONG-TERM CARE PARAPROFESSIONALS: NATIONAL AND LOCAL WORKFORCE SHORTAGES AND ASSOCATED DATA NEEDS
- Study funded by HRSA’s Bureau of Health Professions.
- Objectives of study:
- Review existing sources of data for states.
- Compile latest data.
- Identify strengths and weaknesses of sources.
- Suggest ways to improve the data.
- Full report is posted to HRSA’s website: http://bhpr.hrsa.gov/healthworkforce/reports/nursingandhomeaide.htm.
WHAT IS THE PROBLEM?
- Shortages of front-line workers serving the elderly, the chronically ill and the disabled.
- Service reductions due to shortages.
- Use of temporary workers at higher hourly rates.
- Shortages impact both quality of care and quality of life.
- Between 2000 and 2010, more than 1.2 million long-term care workers will be needed to fill new jobs and to replace those leaving the field.
WORKFORCE SHORTAGE ISSUES
- Demanding work.
- Jobs often not well designed or supervised.
- Low pay.
- Lack of career ladders.
- Aging of population.
- More types of providers.
- New technologies.
NEED FOR BETTER DATA
- Workforce planning.
- Policy formulation.
- Patient safety.
- Quality improvement.
- Program evaluation.
- Consumer information
APPROXIMATELY 120,000 ORGANIZATIONS USED LONG-TERM CARE PARAPROFESSIONALS IN 1998
- Long-Term Care Providers include:
- Nursing homes.
- Intermediate care facilities for the mentally retarded.
- Residential facilities for adults or aged.
- Residential facilities for non-aged.
- Adult day care centers.
- Home health agencies (certified or licensed).
- Hospice organizations (certified or licensed).
- Assisted living facilities.
NINE SOURCES OF DATA
- Bureau of Labor Statistics (BLS)
- Occupational and Employment Statistics (OES).
- Current Population Survey (CPS).
- CPS March Supplement.
- National Compensation Survey (NCS).
- Employment Projections.
- Survey of Occupational Injuries and Illnesses.
- OSCAR (CMS system).
- Decennical Census.
- State CNA registries.
LIMITATIONS OF THE DATA
- Data exclusions
- Lack of detail about states or counties.
- Incomplete coverage of facilities and/or occupations.
- Inconsistencies in definitions.
- Excessively broad categories.
- Self-reported and unaudited.
- Delays in availability.
OPTIONS FOR THE FUTURE
- Upgrade CNA registries
- Cover other providers in addition to nursing homes.
- Add variables relevant to workforce planning
- Add other workers.
- Coordinate with background checks.
- Require annual workforce snapshots on a single day.
- Encourage compatible state-level systems
- Facilitate sharing.
- Provide bases for comparisons.
- Involve provider associations
- They have additional information.
- More and better data is positively correlated with better outcomes.
- Informed workforce planning is needed to:
- Better understand current shortages.
- Assess impact of present and future initiatives to balance supply and demand.
- Current data systems were limited in their ability to assist in such planning efforts.
- Better data on both providers and workers are needed by planners and policy makers.
|Impact of the Aging of America on the Health Workforce|
|Health records technologists||35.3||40.3||+ 5.0|
|Radiologic technicians||34.3||38.0||+ 3.7|
|Registered nurses||37.3||42.7||+ 5.4|
|Respiratory therapists||32.3||38.0||+ 5.7|
|Social workers||38.7||40.3||+ 1.7|
|Speech therapists||35.7||40.7||+ 5.0|
|Total civilian labor force||35.7||38.7||+ 3.0|
|SOURCE: Bureau of Labor Statistics, Current Population Survey - Annual Demographic Supplement, 1988-2000.
NOTES: Figures presented are averages of three years’ data. Civilian labor force only.
|Recipients of LTC in the U.S., 1995|
|Age Group||Setting of Service||All Settings
|Nursing Home||Home or Community|
|65 or Older||1.3 million||5.1 million||6.4 million|
|Under 65||0.2 million||5.5 million||5.7 million|
|All Ages||1.5 million||10.6 million||12.1 million|
|SOURCE: Kaiser Commission, 1999.|
|Workers by Industry Group in 2000|
|Occupational Category||Industry Group|
|Home Health Aides||32.9%||5.4%||22.3%||39.4%||100%|
|Nursing Aides, Orderlies, and Attendants||2.7%||51.9%||4.5%||40.9%||100%|
|Personal and Home Care Aides||30.8%||3.5%||24.1%||41.6%||100%|
|SOURCE: BLS Occupational Employment Survey.|
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