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National Direct Care Workforce Study Finds States Considering the Direct Care Shortage a Serious Workforce Issue (August 16, 2002)

Recruitment and retention of adequate numbers of qualified direct care workers are major concerns for many long-term care providers today, with many providers reporting rising vacancy and turnover rates, and increasing difficulty in recruiting and retaining qualified workers in long-term care services. Many factors are considered symptoms of a workforce shortage, including high vacancy rates, high turnover rates, increasing salaries and/or incentives, and increased use of contract or temporary pool workers. Without national workforce data on these factors, it is difficult to determine the magnitude of the gap between supply and demand of direct care workers. However, national survey results suggest that many states now consider the direct care worker shortage to be a great concern.

The Paraprofessional Healthcare Institute (PHI) and the North Carolina Department of Health and Human Services (NCDHHS) have conducted a national survey and published their findings in a new report--Results of the 2002 National Survey of State Initiatives on the Long-Term Care Direct Care Workforce. The purpose of the study was to obtain updated information from states about actions taken or being considered to respond to shortages of direct care workers; to determine the extent to which the slowing economy has affected direct care worker shortages and/or state actions to address any shortage; and to consolidate, into a single document, previously collected by PHI and NCDHHS.

Between 2000 and 2010, the U.S. Bureau of Labor projects that employment growth for direct care workers will double (36.3%) that of the projected growth in overall employment (15.2%). In fact, one category of direct care workers (Personal and Home Care Aides) ranks as the 8th fastest growing occupation from 2000 to 2010. Between 2000 and 2010, a projected 874,000 additional direct care workers will be needed. This number does not include “replacement” workers for existing employees. When replacement workers are included, the number needed grows to approximately 1.2 million.

Since 1999 when the first national direct care worker related survey was conducted by the NCDHHS, there has been significant increased activity in terms of the number and array of actions taken by states in a deliberate attempt to address shortages of direct care workers and improve the stability, job satisfaction, and job performance of direct care workers in long-term care settings. The vast majority of states have implemented or strategies in an effort to address shortages of direct care workers working in one or more related health or long-term care settings. States are also increasingly conducting efforts to evaluate the impact of any actions taken.

More states are collecting, or have collected, and analyzed/published a variety of data pertaining to the direct workforce. Data collection and analysis efforts have been an important component of various task force efforts and have been instrumental in increasing the visibility given to the workforce issue. Data efforts have included major categories such as: compiling wage/benefit studies and comparing wages of direct care workers to wages of competing job sectors; demographic data pertaining to the direct care workforce (age, job tenure, years working as a direct care workers, job settings, etc.); job growth projections; and turnover data.

Findings

According to the report, the direct care workforce represents a full spectrum of paraprofessional employees working in long-term care, including nurse aides, home care aides, nursing assistants, personal assistance workers, direct support professionals, personal attendant workers and others.

As a result of the slowing economy, many states have had to readjust budgets and agency allocations. Eleven states (25%) have seen a change in programs or initiatives to address the direct care shortage. These changes include decreases in proposed or exiting funding for programs, decreases in requests for appropriations, or decreases in the number and types of services provided.

Twenty-five states (58%) responding to the survey reported some type of coordinated effort to improve staffing conditions for direct care workers. States reporting collaborative efforts with other agencies include: Alaska, Arkansas, Florida, Iowa, Kentucky, Maine, Michigan, Minnesota, Montana, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Carolina, Vermont, Washington, and Wisconsin. Of these, 8 reported collaboration with the Department of Education, 11 reported cooperation with the Department of Labor, 7 states coordinated efforts with the agency responsible for the Welfare-to-Work program, and 18 cited collaboration with other agencies or organizations.

Nine states responding to the survey (21%) reported collecting and analyzing evaluative data on one or more direct care initiatives. States that have collected and analyzed data related to direct care initiatives include: Colorado, Delaware, Florida, Iowa, Kansas, Minnesota, Montana, North Carolina, and Oklahoma.

Eight states reported that they use a uniform methodology for collecting turnover data for direct care workers working in one or more settings. For most states, collection and analysis of turnover data on a routine basis is a new effort and trend data is not yet available.

Ten states (23%) reported the amount (or known amount from a particular funding source) being spent on training for direct care workers with Medicaid, Temporary Assistance for Needy Families (TANF), Workforce Investment Act (WIA), or other governmental funds. The amount spent on training for direct care professionals varied greatly from $35,000 in Alaska over a 6-month period to over $7 million in Medicaid dollars in Michigan, $15 million in Pennsylvania, and $80 million in TANF funding in New York.

Fourteen states (33%) reported pending legislation directly related to direct care workers. Nine states (21%) reported having pending legislation dealing with nursing shortages. These initiatives included: support for loans and scholarships, loan forgiveness programs, salary exemption from personal income tax considerations for certain types of RNs, and legislative study commissions.

The report concludes that shortages of direct care workers continues to be major workforce issue for states, in spite of the slowing economic environment. States reporting a lessening of the severity of the shortage identified reasons that are primarily due to temporary factors in the stability of the state’s direct care workforce. Of the 43 states that responded to the national survey, 37 (86%) consider the direct care shortage to be a serious workforce issue.

The report includes a state specific chard outlining major actions taken in several key areas. The summaries provide opportunities for states to learn from each other and share best practices. The charting of state actions also offer ANCOR members with key strategies to pursue with their states.

Click here for a copy of Results of the 2002 National Survey of State Initiatives on the Long-Term Care Direct Care Workforce

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