Investments in recruitment, retention and career advancement opportunities are needed to stem the shrinking direct care workforce, researchers said Thursday in Health Affairs.

“Supporting DCWs is a health system imperative; inertia in this area presents a significant risk of workforce shortages with consequences for quality of care and sustainability of our long-term support system,” according to the research team led by Sheryl Strasser, PhD, at the Georgia State University School of Public Health. 

The authors, as McKnight’s previously reported, emphasized the loss of frontline workers in nursing homes as a factor that has contributed to an estimated 55% of skilled nursing facilities limiting admissions, per the American Health Care Association.

Older caregivers represent a disproportionate amount of the direct care labor force, the authors noted. With fewer younger people entering the field, projections indicate a shortfall of more than 150,000 direct care workers by 2030 and 355,000 by 2040.

Investing in career advancement opportunities is essential to recruiting and retaining direct care workers, they said. Advancement opportunities should include career trajectories, including in administration, education and advocacy, as well as opportunities to liaise with other professionals, the authors said.

All of this takes money. 

“The business of caring is costly — to the system, to clients, and to DCWs who have little to no incentive to stay in their job even though our economy and healthcare system relies heavily on DCWs,” they wrote. “Developing opportunities for growth within the direct care workforce is imperative for promoting the well-being of our professional caregivers, the clients and families they support, and the sustainability of our long-term care service system.”

The authors proposed that the Biden administration set aside a portion of the $400 billion it plans to spend on home- and community-based services for local organizations to help shore up the pipeline of direct care workers.

“When these organizations receive grants, they can use these funds to train DCWs (for example, students) to provide specialized support to other DCWs and family caregivers in different ways,” according to the researchers. “For instance, one pathway could involve training DCWs as caregiving coaches to support other DCWs within their organization as well as family caregivers in their local or cultural community.”