Pathway to the Future: How Workforce Development and Quality Jobs Can Promote Quality Care Conference Package. Nature of the Problem

05/01/2004

Across the United States, there is growing concern about current and projected shortages of frontline, direct care workers who provide care and services to the elderly, chronically ill, and disabled. National studies cite annual turnover rates in nursing homes ranging from 45 to 105 percent (Stone, 2001). In 1999, Ohio's nursing assistant turnover rate ranged from 88 to 137 percent while in Florida, only 53 percent of the state's certified nursing aides (CNAs) were working in a health-related field one year after certification. Long-term care provider organizations have either reduced services due to shortages of permanent staff or, alternatively, hired temporary replacement staff at significantly higher hourly rates (Forschner et al., 2001). In areas where levels of service have been reduced, elderly or chronically ill persons deprived of access to care must either remain in more restrictive, more costly environments (notwithstanding the Supreme Court Olmstead decision affirming the right of nursing-home-eligible people to live in the "least restrictive" setting) or seek care from family or friends. Both quality of care and quality of life suffer as people are denied services, or services are provided by persons less qualified or experienced.

Over the next several decades, as population aging and advances in medicine increase the number of persons living with chronic medical conditions, the need for long-term care workers will continue to grow. The Bureau of Labor Statistics (BLS) projects that between 2000 and 2010, an additional 1.2 million nursing aides, home health aides, and persons in similar occupations will be needed to (a) cover the projected growth in long-term care positions and (b) replace departing workers. This rapid increase in demand--over half the year 2000 supply--can be expected, for similar reasons, to continue well beyond 2010. The pool, however, from which such workers have traditionally been drawn--largely women between 25 and 50 without post-secondary education--continues to shrink. It is questionable, therefore, whether the Nation will have an adequate supply of workers in these occupations to meet the expected increase in demand.

Nursing aides and home health aides provide much of the care in long-term care settings, both in nursing homes and in the community. Policymakers and the health care community have sought to understand the problems in maintaining an adequate supply of such healthcare workers. While some studies have led to an improved understanding of these occupations and the causes of the shortages, they have tended to rely on case studies, focus groups, and data that are incomplete. The lack of system-wide data has weakened efforts to understand the scope of the problem and to develop programs and policies that could address it.

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