This report focuses on nursing aides and home health aides, two of the major occupations responsible for providing patient care of a paraprofessional nature to chronically ill, disabled, and elderly persons in nursing homes and other institutional or community-based settings as well as at home. Faced with an aging population and a material shift of patient care to non-hospital venues, the Nation is experiencing an unprecedented demand for individuals with the training and experience needed to provide such care. There is a high turnover rate associated with these occupations, the result of a variety of factors relating to job satisfaction, such as low pay, lack of a career ladder, and occasional less than ideal treatment by supervisors. As a consequence, the supply of these individuals, while continuing to grow, has been slipping relative to demand, a situation likely to continue well into the future.
Because of the importance of this segment of the health workforce in meeting the care needs of an increasing percentage of the population, the National Center for Health Workforce Analysis (NCHWA) in the Health Resources and Services Administration's (HRSA) Bureau of Health Professions (BHPr) has commissioned and directed this study. The study concludes that informed workforce planning is needed to document the extent of existing shortages in these occupations and thereby assist states and institutions in addressing them, as well as to assess the impact of present and future initiatives to balance supply and demand. Current data systems were found to be limited in their ability to assist in such planning efforts. They do not, for the most part, accurately estimate the supply of individuals working in these occupations, including their numbers, locations, characteristics, and qualifications.
The comprehensive assessment presented in this report was based on a review of eight key Federal datasets, certified nursing aide registries in 45 states, and fieldwork in four states (California, Illinois, New York, and Wyoming). The fieldwork included interviews and focus groups with long-term care providers and State officials to assess both their current data collection activities and the data needed for future program and policy development. The project was guided by an expert advisory panel and interviews with leaders in the long-term care field. These efforts, along with a review of the literature, resulted in (a) confirmation that there exists a widespread shortage of long-term care paraprofessionals and (b) affirmation that the shortage is likely to be far more severe in the future. The report concludes with a series of suggested strategies for improving data collection relating to these occupations, building on existing datasets and data collection activities.
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