Across the country, the stories are the same. A family can't find a home care worker to assist an aging parent. A local home care provider struggles to recruit workers—these workers in turn flee the sector, fed up with the quality of these jobs. This cycle repeats, the problems multiply by the year, and the workforce shortage explodes into a national crisis affecting millions of long-term care consumers.
Where is the federal response? How can we move forward?
This week, PHI—a research and consulting group, and a leading authority on the direct care workforce—issued a federal report to begin answering these questions. The premise of the report is that the quality of care we receive as individuals relies on the quality of jobs for people who provide that care. Yet this aspiration remains largely unfulfilled, to the detriment of millions. Federal reform can change this.
Direct care workers—nearly 5 million home care workers and nursing assistants across the U.S.—represent the largest growing occupation in the country, yet they face numerous obstacles. The primary barrier is that direct care jobs are typically low pay with few benefits, and because most employers keep these workers at part time, many of these workers don't earn sufficient incomes to avoid poverty. Frustrated, they leave the sector. Additionally, training standards and training opportunities are generally thin and sporadic across this workforce, especially among personal care aides, which lack any federal standard. Insufficient training affects both the worker, who doesn’t get the skills needed to take on more complicated tasks, as well the client, who can’t be assured they have a competent caregiver.
Developing an effective policy intervention would require reliable workforce data, yet most federal and state systems don’t track variables such as staffing statistics, vacancy rates, or annual incomes, to name a few. Without this systematic data, lawmakers cannot accurately determine the supports that are needed or where to invest them. Moreover, many individuals can’t access long-term services and supports because of high costs or because they live in remote, often rural, areas with few resources. Communities of color and immigrants too often encounter services that are culturally and linguistically inaccessible. Family caregivers—who provide most long-term care, donating $470 billion in annual care to loved ones—increasingly struggle to find care workers to support them in times of need.
The Trump administration and Congress can begin correcting these concerns. The benefits achieved through Medicaid expansion—which brought increased economic stability to half a million workers who gained coverage--should be protected. Additionally, laws should enforce new wage and overtime protections for home care workers, as well as enact broad family and medical leave policies. Federal lawmakers should improve training standards for direct care workers and fund training programs related to Alzheimer’s and diabetes, as two examples. The federal government should work with states to collect better data on the workforce, including data that assesses the quality of long-term services and supports, and promote culturally and linguistically appropriate services across the long-term services and supports system. Finally, more research and initiatives are needed to fortify the relationship between family caregivers and paid caregivers. Our new federal report expands on these ideas and proposes many more.
The most far-reaching reason to invest in this workforce remains less visible. As the U.S. population rapidly ages, the long-term care industry will boom, creating millions of job in the decades ahead. From 2014 to 2024, direct care will add one million new jobs, outpacing demand for fast food workers, retail salespeople, teachers, police, and firefighters combined. Yet if these jobs are weak and leave most workers in poverty, their economic contributions are minimized and the broader economy suffers. And what does it mean that the largest number of jobs in the coming years will be created in a field where people can't earn a decent living? Economic growth is tied to the success of the long-term care sector and direct care. When we invest in this workforce, we invest in the quality of care, and as importantly, we invest in our economic future.