Pathway to the Future: How Workforce Development and Quality Jobs Can Promote Quality Care Conference Package. Long-term Care Paraprofessionals: National and Local Workforce Shortages and Data Needs (1)

05/01/2004

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

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

  • Supply
    • Demanding work.
    • Jobs often not well designed or supervised.
    • Low pay.
    • Lack of career ladders.
  • Demand
    • 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
      • Demographics
      • Workload
    • 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.

IN CONCLUSION

  • 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
Median Age 1989 1999 Change
1989-1999
Dentists 40.7 44.0 + 3.3
Dietitians 38.3 40.0 + 1.7
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
Pharmacists 36.7 41.3 + 4.6
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
Combined
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 Care
Nursing and
Personal Care
Residential
Care
Other Total
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.

 

 

 

 

 

 

  1. This presentation is available online through the Center for Health Workforce Studies website at http://chws.albany.edu/index.php?id=12,0,0,1,0,0.

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