Improving The Long-Term Care Workforce Serving Older Adults

Abstract

There is a worsening shortage of competent, committed, paid long-term care workers who are able to meet the needs of older adults. Efforts to address the shortage must be informed by a conceptual framework that acknowledges the unique circumstances affecting these workers. These include nontraditional market forces, low compensation and prestige, limited career opportunities, and inadequate preparation for evolving roles and responsibilities. Applying this framework, we identify strategies that can reverse current trends by expanding worker supply; improving education, training, and developmental activities; and making delivery of long-term care services and supports to older people a more attractive alternative to employment in acute and primary care settings.O ne essential element of long-term care policy has, until recently, received relatively little attention: ensuring the availability of a competent paid workforce to deliver needed long-term services and supports. The empirical and policy literature, and the authors' observations and many years of experience in long-term care policy development and research, suggest that future workforce planning and improvement initiatives should be guided by four principles. These are as follows:(1) Conventional rules of supply and demand and traditional sources of labor cannot be counted on to resolve future workforce shortages.(2) To compete for and properly develop workers, long-term care must be recognized as a distinct sector within the larger health care sector.(3) Workforce roles and responsibilities must be responsive to a new array of service delivery models and to the increasingly complex and diverse needs of clients.(4) The competencies that are needed to work in the long-term care field must be defined and put into practice before careers in long-term care can be widely recognized as worthy, and workers accorded a status equal to that of their peers employed in acute and primary care.In keeping with these principles, we present a framework for improving the supply of paid workers available to deliver long-term care services and supports to people age sixty-five and older. Such people differ somewhat from younger populations with respect to needs, preferences, and goals-particularly in the areas of school participation and employment-and, therefore, merit separate consideration. Yet several of the points raised, and recommendations offered in the following pages, are as applicable to paid caregivers serving children and workingage adults as to those serving older adults. Who Provides Paid Care To Older Adults?The paid ("formal") long-term care workforce serving America's elderly population is made up of licensed professionals and unlicensed direct care workers who manage and deliver longterm care services in nursing homes, assisted living facilities, other residential and commu-

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