Factors affecting supply. The high turnover and vacancy rates associated with these occupations are consistently found to be the result of job dissatisfaction stemming from the following:
- Jobs are physically and emotionally demanding. Many nursing home injuries consist of back problems resulting from lifting or transferring residents, a high rate of injury corroborated by data from the BLS Survey of Occupational Injuries and Illnesses (BLS, 1999). Patient load in many nursing homes is excessive; the consequent pressure to "speed up" results in increased job stress (Wilner, 1994; Foner, 1994; Diamond, 1992).
- Wages and benefits are generally not competitive with other available jobs (Case et al., 2002; Himmelstein et al., 1996).
- Jobs are often not well designed or supervised (Kopiec, 2000), with few or no opportunities for advancement. Workers perceive a general lack of respect from management.
Factors affecting demand. Factors responsible for the increased demand for long-term care include:
- Aging of the population as baby boomers advance to the ranks of the elderly.
- Technological advances that extend the lives of those with chronic ailments.
- The greater availability of services in less restrictive, less costly community settings.
Population aging, in and of itself, might present less of a problem if the supply of care providers were growing at approximately the same rate. Unfortunately, it is not. It is growing at a significantly lower rate--not only are providers leaving the field for reasons of job dissatisfaction but the pool from which such providers have typically been drawn in the past has been dwindling compared to the growth in demand due to aging. In 2000, there were 1.74 females between the ages of 25 and 54 for every person 65 and older; by 2030, that ratio is projected to drop to 0.92 (calculations based on Census Bureau National Population Projections). Since women provide the majority of both paid and family-provided long-term care, this "care gap" will increase. Families unable to care for their loved ones by themselves will find, when they turn to the formal system for assistance, relatively fewer paid staff available.
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