California’s senior living and care sector is at a “critical juncture,” with the state Master Plan on Aging underscoring the need to expand the direct care workforce and improve outcomes for workers, according to a new report from the Public Policy Institute of California.
The institute recently released the report and an accompanying policy brief on the needs, opportunities and challenges facing the states’ care workforce, including direct care workers in assisted living communities.
LeadingAge California called the older adult care workforce “one of the most pressing issues facing our state” and lauded the institute’s work to “shine a light” on the growing needs of the workforce and assisted living challenges.
“For years, LeadingAge California has been actively engaged in advocating for impactful policy and budget solutions to address many of the key findings outlined in the report,” Vice President of Regulatory Affairs Meredith Chillemi told McKnight’s Senior Living, who said the organization’s flagship programs within The Gateway-In Project enhanced economic security for existing direct care workers while bolstering the new talent pipeline. “Thanks to these programs and the work of our members, we help recruit and retain direct care workers in home-based, skilled nursing and assisted living settings that support older adult communities throughout the state.”
The California Assisted Living Association agreed that meeting workforce demands for caregivers presents “tremendous challenges” in California as a “high-cost state.”
“California’s Master Plan for Aging — which is referenced in the PPIC report — highlights the need for a larger and well-trained workforce to meet the needs of our state’s rapidly growing over-60 population,” CALA President and CEO Sally Michael told McKnight’s Senior Living. “CALA members understand this priority and have joined our organization to ensure they have access to training and resources, which allows them to utilize best practices both for their workforce and residents.”
Personal care and home health aide jobs are among the fastest-growing jobs in the state, projected to increase 29% by 2030 to 1 million jobs, whereas certified nursing assistant jobs are projected to grow by 13%, according to the report. And policy reforms aimed at expanding financing options for long-term care — including Medi-Cal paying assisted living communities or a payroll tax to fund long-term care for most workers — could increase demand for direct care workers.
According to the Public Policy Institute of California, demand for assisted living jobs will grow by 31%, compared with 27% for home health care and 15% for skilled nursing facilities. As care for older adults and people with disabilities shifts from nursing homes to home- and community-based settings over the past few decades, largely driven by changes to Medicaid policy and case law, as well as personal preference. As a result, jobs in HCBS are expected to grow 27% by 2030.
The report authors noted that increased demand for assisted living communities could alter the settings in which older adults receive care and services. But higher costs and minimal government funding support could limit the growth of those jobs.
“Ongoing policy efforts that expand coverage and payment sources for caregiving services in assisted living facilities and home-based settings could also shift where caregiving services are provided,” the report read.
Cost of care presents unique challenge
Another challenge is the high cost of direct care services in California, the authors said.
According to a Genworth Cost of Care Survey, annual costs in 2023 averaged $75,000 for assisted living communities, $76,000 for full-time in-home healthcare, $22,000 for adult day, and $137,000 (semi-private room) to $159,000 (private room) in nursing homes.
Those costs are higher than the national median of $64,000 for a one-bedroom unit in assisted living, $69,000 for a full-time home health aide and $117,000 for a private nursing home room, the report noted.
In general, the authors said, the high cost of private care services and the large governmental role in covering the costs of caregiving make it challenging to increase pay in order to both draw in new workers and improve jobs for existing workers.
Investing in workforce key to retention, recruitment
A key workforce challenge is worker retention, according to the report. Care workers are more likely than workers in other sectors to change employers or leave the labor force within just a few years of starting a job, according to the report. And attracting new workers to jobs that offer low wages and limited advancement opportunities is difficult.
The report suggested that efforts in key areas to improve prospects for care workers and help California meet its need for caregiving services, including investing in well-defined career pathways, improving economic security for care workers, and better integrating direct care workers into health sectors.
For the future, the authors said, it will be important to monitor progress on master plan workforce initiatives and additional investments in training for care workers. It also will be critical to create more robust ways to integrate available administrative and licensing data to evaluate how policies and increased funding are affecting the number of people working in the care sector, and to monitor the effects on workers’ economic well-being.
“Though the pandemic deeply impacted the care workforce, it also raised the profile of how important caregiving is not just to the people who need services and their families, but to the broader economy,” the authors concluded. “While major federal reforms have stalled, California will need to do more to create and sustain a robust care workforce.”
