Direct care workforce shortages strain the healthcare system overall and affect access, quality and costs. Although no single answer to the issue exists, several policy initiatives and solutions underway could aid in recruiting and retaining more workers, a panel of experts recently shared.
Three key challenges contributing to the direct care workforce shortage are inadequate support for workers, a lack of data on the workforce and untargeted workforce programs, Allison Buffett, MPH, a Bipartisan Policy Center senior policy analyst, identified during a webinar hosted last week by the Administration for Community Living Direct Care Workforce Strategies Center and the BPC.
Those challenges, she said, affect recruitment and retention, hamper policymakers’ ability to understand and tackle the shortage effectively, and limit workforce growth. And although the direct care workforce grew from 3 million to 4.6 million between 2009 and 2019, experts anticipate significant gaps in the number of available workers versus the number needed, Buffett added.
By 2032, there will be more direct care workers jobs than in any other occupation, according to PHI Vice President of Research and Evaluation Kezia Scales, PhD. And although the data tell a very high-level story of direct care worker recruitment and retention challenges, they lack details to quantify the shortages, she said.
High-level national estimates of turnover rates also exist, but no robust data on runover, retention and job vacancies exist at the state and local levels, Scales said. Little is known about the training workers complete, their skill sets or skill and training gaps, she added.
“All of these data points are critically needed to be able to describe workforce challenges in any given state, to identify solutions and to evaluate which solutions make a difference or not to move ahead and make incremental progress,” Scales said. PHI, she added, is conducting interviews for the Direct Care Worker Strategies Center to learn about workforce data collection across states to identify where gaps and opportunities exist. “Without better data, there is nothing for us to say, no problems to solve, no recommendations to make.”
The recently released final Medicaid Access Rule, Scales said, will add impetus to data collection and underscores the need to learn from and replicate what states already are doing well.
The rule requires that at least 80% of Medicaid home- and community-based services payments to providers be put toward wages for direct care workers, including payments for personal care, homemaker and home health aide services. States will have to publicly report when they meet the 80% threshold for direct care worker compensation as well as meet the rule’s quality and performance measures, she said.
Data collecting to inform policy making also is happening through existing survey instruments, including the National Core Indicators for Aging and Disabilities, which measures service outcomes by state Medicaid aging and disability agencies. Scales said states also are leveraging managed care contracts to promote better data collection, and some states have built workforce-specific data indicators into existing touch points with providers to build out workforce knowledge, inform policy making and decision making, while minimizing the impact on providers.
Building momentum
The good news, Buffet said, is that solving issues related to the direct care workforce shortage is a bipartisan issue and a priority for the Biden administration. The stage is set for reform opportunities to create sustainable, supportive work environments; to increase the number of new workers; and to improve data on workforce characteristics, she said.
Through the American Rescue Plan Act, many states adopted innovative strategies to increase direct care worker compensation, Buffet said. Also important are reforms to develop training to support recruitment and retention, as well as to strengthen existing workforce development programs.
States are grappling with how to build out benefits and support for direct care workers beyond wages and benefits, Scales said, adding, however, that many examples exist of progress in that regard, with some states offering health insurance for workers and their dependents, retirement and training benefits, housing, childcare and even a shoe allowance.
With family caregivers contributing a large portion of care for their loved ones, said Antoinette Gingerelli, MPP, National Alliance for Caregiving director of policy and advocacy, there are programs focused on elevating the bond between those family caregivers and paid caregivers, including care integration teams, matching service registries, and a pilot program focused on training family caregivers and direct care workers on how to interact with each other, to ensure a common language and understanding across the two groups.
The momentum to address workforce shortages, which is real despite the lack of data, reflects a widespread effort involving a lot of different partners, including recent executive orders, congressional hearings, legislation and federal rules, Scales said.
“We have these opportunities, and we have a lot of learning from the past few years,” she said. “We have to harness that and pull forward together in a direction that leads us to more transformational change than has been seen up until this point.”
There is no single solution that will fix workforce shortages, BPC Health Program Director Lisa Harootunian, JD, said, but progress is possible with a range of reforms creating supportive environments for direct care professionals and family caregivers. That range includes providing competitive compensation, increased training and workforce development, and the data to measure the effects of efforts over time.
“Looking ahead, I’m hopeful we can make some progress forward to support the direct care workforce,” Harootunian said.
