Workforce Policy

Part of: Center for Workforce Solutions

The Issue

The US has a significant shortage of, and a growing demand for, qualified workers who are capable of managing, supervising and providing high-quality services and supports for older adults. The population of adults age 65 and older will increase from nearly 50 million in 2015 to 88 million in 2050 – an 84% increase. The US Department of Health and Human Services estimates that nearly 7 out of 10 people who reach age 65 ultimately will need some form of long term services and support (LTSS). Thus, the nation will need 2.5 million workers of all different types by 2030 to keep up with the growth of America’s aging population. Unfortunately, current recruitment and retention of workers of all kinds is an ongoing challenge for a number of reasons. Medicaid is the primary public funder of LTSS services and low reimbursement rates limit salaries for all positions. This is particularly true for those who work in direct care. The reality is that jobs in aging services are highly skilled and complex, a fact not recognized in pay scales or reimbursement rates. In addition, work in these settings is physically and emotionally demanding. And, we continue to work towards improving workplace cultures. Finally, immigrants have a growing role in the LTSS workforce and there is potential value for the quality and sustainability of the LTSS field; in fact 24% of direct care workers are foreign-born.

Our Position

We support a number of legislative and regulatory solutions:

  • The design and implementation of a foreign worker program in which workers come for a specified time to work in LTSS and then return to their native countries;
  • Expansion of the H (1)(b) visa program to include positions related to LTSS;
  • Creation of scholarships similar to the National Health Service Corps for students to work in aging services;
  • Education of lawmakers about the reliance of our communities on immigrants and migrants;
  • Amendment of current Medicare law to allow Graduate Medical Education (GME) funds to support training for staff in the LTSS field;
  • Funding for education and training programs with added focus on the LTSS field;
  • Exploration of demonstration projects at the Department of Education to create programs that expose youths from grades K-12 to the diverse field of aging services, or alternatively require a demonstration project through legislative language;
  • Exploration of a demonstration project at the Department of Health and Human Services building on the experience in New York in which MLTSS plans are required to contract with regional workforce investment organizations to provide training and technical assistance around developing the workforce;
  • Exploration of apprenticeship programs in LTSS at the Department of Labor.

Key Resources


  • Bipartisan legislation, S. 2888, the Geriatrics Workforce Improvement Act, would reauthorize the GWEP program and reinstate Geriatric Academic Career Awards to train those who will teach the healthcare professionals of the future. The bill was introduced by Sens. Susan Collins (R-ME) and Bob Casey (D-PA). Similar legislation, H.R. 3713, has been introduced in the House by Rep. Jan Schakowsky (D-IL) also with bipartisan cosponsorship.
  • The Improving Care for Vulnerable Older Citizens through Workforce Advancement Act, H.R. 3461, would establish demonstration projects to test the use of direct-care workers - nursing assistants, home health aides, or personal care aides - in advanced roles. These demonstration projects would study care coordination and improved delivery of health services for older adults with chronic illness or at-risk of re-hospitalization. The demonstration projects would be funded through the Older Americans Act. Two projects would incorporate direct-care workers into interdisciplinary care coordination teams to promote smooth transitions in care and help to prevent unnecessary hospital readmissions. Two projects would focus on maintaining and improving the health status of older adults with multiple chronic conditions and long-term care needs. Direct-care workers will help monitor health status, help consumers follow prescribed care, and educate the consumer and family caregiver(s). The remaining two projects will train direct-care workers to take on deeper clinical responsibilities related to specific diseases, such as Alzheimer’s, dementia, congestive heart failure, and diabetes.
  • The Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act, H.R. 3778, notes the growing need for direct care workers, as cited by the Bureau of Labor Statistics and the National Academy of Medicine. The legislation would establish grants under the Department of Labor for demonstration projects on the recruitment and retention of direct care workers and the expansion of career advancement opportunities for them.
  • The Emergency Nursing Supply Relief Act, H.R. 3351, would provide up to 8,000 employment-based immigration visas per year for nurses, physical therapists, and other healthcare workers. This legislation would help to ease the present nursing shortage by allowing more of these healthcare professionals to fill job vacancies here in the United States.