# Presentation: 213572

## Caregivers and Quality in Long Term Care

**Edward Salsberg, Ph.D.**
- Executive Director
- Center for Health Workforce Studies
- School of Public Health
- State University of New York
- at Albany
- _[http://](http://chws.albany.edu/)__[chws.albany.edu](http://chws.albany.edu/)_

**Notes:**
This is Edward Salsberg’s title slide.

## The Health Workforce Crisis

- Serious shortages threatening ability to deliver services
- The squeeze -- few new dollars and the high cost of more workers
- Concerns with medical errors and quality
- Worker and management dissatisfaction
- Buried in paperwork and regulation
- Racial and ethnic imbalances
- Decreased interest in health careers
- Lack of systematic data on workforce needs

**Notes:**
This is a description of the health workforce crisis in the United States.

## Factors Contributing to Health Workforce Shortages

- Short term factors
- Educational system response lags
- Rising demand
- Increasing case mix complexity
- Long Term factors
- The aging of America: increasing demand and decreasing supply of workers
- Increasing demand due to increasing income, expanding interventions, and increased survival of individuals with chronic illness
- Changing racial/ethnic mix
- Expanded career choices for women

**Notes:**
This lists the short term and long term factors contributing to health workforce shortages.

## Factors Contributing to Health Workforce Shortages, continued

- Workplace factors
- Physically and emotionally demanding work
- Non-competitive wages and benefits
- Job design and working conditions
- Paperwork and lack of information systems
- Poorly trained managers

**Notes:**
This lists the workplace factors contributing to health workforce shortages.

## Employment in Health Care Is Expected to Grow Rapidly in Coming Years

- The Bureau of Labor Statistics (BLS) forecasts that **employment in all health care occupations** will grow by 29% between 2000 and 2010, twice as fast as the rest of the economy.
- Total **job openings** due to growth and replacements between  2000 and 2010 are forecast to be:
- Registered Nurses		           1,004,000
- Nurse Aides, Orderlies, Attendants 	 498,000
- Home Health Aides		  	 370,000
- Personal and Home Care Aides	 	 322,000
- Licensed Practical Nurses	 	 322,000
- Bureau of Labor Statistics: Occupational Employment Projections to 2010,
- 	Monthly Labor Review, Nov 2001

**Notes:**
This shows that employment in all health care occupations is expected to grow rapidly in coming years, as evidenced by increases in total job openings.

## Direct Care Workers Comprise the Majority of Workers in Long Term Care

- Home Health Care Workforce
- 50% Home health aides and other aides
- 19% RNs
- 6%  LPNs
- Nursing Home Workforce
- 38% CNAs and other aides
- 11% LPNs
- 9% RNs

**Notes:**
This shows that direct care workers comprise the majority of workers in long term care, specifically in the home health care workforce and the nursing home workforce.

##    Long Term Care Aide Shortages:	A.  The Worker Perspective 

- Low wages and benefits
- 	(Certified Nurse Aide:  $9.22 per hour; Home Health Aide: $8.38 per hour)
- Alternative jobs
- Poor working conditions
- Difficult jobs – physically/mentally demanding
- Lack of career opportunities: dead end jobs
- Lack of recognition or status
- Poor treatment
- Gap between training and real job demands

**Notes:**
This shows the direct care worker’s perspective on the long term care aide shortages.

## Long Term Care Aide Shortages:	B. The Provider Perspective

- Too little reimbursement
- State and federal regulations and oversight
- Poorly prepared workers
- High turnover
- Low unemployment rate
- Increasing patient acuity
- Growth in total number of jobs

**Notes:**
This shows the provider’s perspective on long term care aide shortages.

## State Government Roles Related to the Health Workforce

- Licensure and regulation of health professionals
- Regulation of health facilities
- Regulation of educational programs
- State colleges and universities
- Medicaid reimbursement policies and regulation of private insurance
- Labor Department training programs and employment data collection
- Employer in state facilities and agencies
- Health workforce data collection

**Notes:**
This shows the various state government roles related to the health workforce.