As a generation grows older, concerns loom over how a health care industry is going to meet the demands of its needs.
Experts agree that the United States is on the path of a potential staffing crisis within the long-term care industry. They just can’t put a finger on how sever that will become.
The U.S. Bureau of Labor Statistics sees the need to add 1.1 million workers — personal care aides, home health aides and nursing assistants — by 2024, a 26 percent increase over 2014. Another study more than doubles that estimate. The Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco published a report in 2015 that estimates staffing demands for long-term care workers will rise by 2.5 million in less than 15 years.
The study predicts there will be little impact on demand for new workers even if long-term care use shifts from institutional care to home-based care.
“Even if 20 percent of elderly patients move out of nursing homes into home health care, which would be huge change, the projected increase in demand for long-term care workers would only drop from 79 percent to 74 percent,” said lead author Joanne Spetz, PhD, professor at the UCSF Phillip R. Lee Institute for Health Policy Studies and associate director for research strategy at the UCSF Center for the Health Professions. “Filling these jobs will be a big challenge under any scenario.”
Spetz and his fellow authors note that 20 percent of Americans will be 65 years or older by 2030, and that 19 million adults will need long-term care services by 2050, up from 8 million in 2000.
The industry is challenged to meet the growing need for health care workers. Entry-level positions on average provide an under-whelming $10 an hour, and some argue that the career path provides little opportunity to advance. The UCSF report points to policy makers and educators to “redouble” efforts in recruiting, training and maintaining long-term care workers.
“Health care workers are the backbone of public health system,” said New York State Assembly Speaker Carl Heastie. “We want to ensure that New York’s dedicated nurses are provided sensible and manageable workloads so they can focus on providing excellent care for each of their patients.”
While the UCSF report published in the June 2015 edition of “Health Affairs,” New York state was already working to address the issue. The state passed a bill to require acute care facilities and nursing homes to adopt minimum staffing requirements, establishing a safe nurse-patient ratio.
The bill would require a hospital or nursing home’s application for an operating certificate to contain a staffing plan with standards for nurse-patient ratios and require compliance with the standards established. Additionally, it would require acute care facilities to publicly disclose their staffing requirements and direct the Department of Health to consider an applicant’s staffing violations when reviewing applications and renewals for its operating certificate.
“The number of patients assigned to a nurse has a direct impact on the quality of care that nurse can provide,” said Assemblymember Aileen Gunther. “This bill would go a long way to improve patient care and reduce incidences of adverse outcomes for health care facilities.”
Health Committee Chair Richard Gottfried cited research published in the Journal of the American Medical Association to substantiate the need to focus on a healthy patient-to-nurse ratio.
“Safe staffing saves lives, improves outcomes and reduces avoidable patient injuries,” said Assemblymember Gottfried. “Research published in the Journal of the American Medical Association (JAMA) determined the odds of patient death increased by seven percent for each additional patient the nurse must care for at one time. The ratios and hours specified in this bill are based on peer-reviewed and evidence-based recommendations, and will ensure that hospitals and nursing homes are safer and provide higher quality care.”
The UCSF study analyzed current long-term care usage patterns by age, gender and race, and projected those patterns into the future. Authors then created a series of alternative scenarios in which patients increased or decreased their current usage, and shifted them from nursing home care to home health care or assisted living.
There is a silver lining to the impending staffing crisis: job growth.
“In the end, to our surprise, none of these changes made a substantial difference in the projected demand for long-term care workers,” said Spetz. “We’re looking at a big increase in jobs, no matter how the demographics play out.”
According to the UCSF study, the occupations projected to grow the most over the next 15 years are counselors and social workers at 94 percent, community and social service workers at 93 percent, and home health and personal care aides at 88 percent.
“In terms of sheer numbers, the greatest need is going to be for home health and personal care aides, with well over one million additional jobs by 2030,” said Spetz. “The challenge is that these are currently very low-paid, high-turnover, entry-level positions. A lot of people in these jobs are living in poverty while working full time. We have to figure out how to make them sustainable.”
Only a few states have any kind of training requirement for home health or personal care aides, noted Spetz. In addition, she said, “there is not much evidence that these jobs are ladders to higher-skilled health occupations. Unless the system begins to offer these workers a pathway for moving into nursing or case management, for example, these jobs will continue to be a revolving door to unemployment and jobs in other low-wage industries.”
Some health care providers are trying to jump ahead of the curve, offering on-the-job training. Jobs are opening for those fresh out of school, or newly retired.
“We, as a company, have a massive amount of employment opportunities,” said Kristin Hoin, staffing agency manager at Attentive Care of Albany, Inc.
Attentive Care provides a path for continued independence and a happier lifestyle for its clients. It’s also a facility staffing agency that provides facility staffing services, and employment opportunities in programs that provides free personal care aide training, and a free PCA certificate upon completion. It also specializes in RN, LPN, CNA, HHA, and PCA jobs.
“For people who are looking for free training to enter this field, we are really anxious to pull from a new pool of people.” She added that, beyond the requirement to be 18-years old, potential employees can range from looking towards their first job, to someone looking to take on a part-time job during retirement.
While Attentive Care and other health care providers take steps to address this anticipated increase in demand, families are also encouraged to make preparations for the future.
“A lot of people have Medicare, and think that will take care of all the needs that they have, but usually Medicare only takes care of short-term,” said Kelly Ottinger, in-take specialist at Attentive Care. “So, after that, [families] don’t always know who to turn to.” Ottinger suggest speaking with an Elder Care attorney, before long-term care services are needed, to preserve personal estates and research specialty trusts that can ultimately assist with future expenses. For families already looking, Ottinger and her staff are able to look into various care options, and the means to finance them.
“It speaks to the importance of people planning ahead, and educating themselves prior to having to make that phone call,” said Hoin. “You don’t want to be the family who lives out of town, that gets the phone call mom had a stroke. … Most people have not purchased long-term health care insurance. … People should plan ahead, speak to an Elder Care attorney and be educated on what’s available.”
Michael Hallisey is managing editor of Spotlight Newspapers.