July 1, 2021, Washington, DC—Aging services leaders today laid out a long-range vision for reimagining America’s professional direct care workforce across long-term care settings.

The report comes as Congress debates President Biden’s proposal for historic investments in home & community-based services—and as recent polling shows that large majorities of Americans from both parties agree. The vision includes recommendations to increase compensation for direct care professionals, in part by increasing Medicaid reimbursement rates (also detailed in LeadingAge’s recent Blueprint For A Better Aging Infrastructure).

The vision is built on six strategies: expanding the caregiver pipeline, strengthening education and training, facilitating career advancement, increasing compensation, preparing universal workers, and reforming the long-term services and supports (LTSS) financing system.

“Care workers like nursing assistants, personal care aides, and home health aides are the heart of aging services. The COVID pandemic shed new light on how valuable these professionals are, but also made clear that America does not have the infrastructure for aging services that we need,” said Katie Smith Sloan, president and CEO of LeadingAge. “This vision sets out a path toward the sustainable, reimagined workforce of professional caregivers that our nation needs to ensure better care for millions of older Americans.”

The report, Feeling Valued Because They are Valued, was released by LeadingAge, the national association of more than 5,000 nonprofit aging services providers, and researchers at the LeadingAge LTSS Center @UMass Boston, which conducts applied research to bridge policy and practice, helping government makers and providers improve older adults’ quality of life.

“Professional caregivers provide support to 20 million older adults, but many more are needed as the number of older Americans surges,” said Robyn Stone, Senior Vice President of Research at LeadingAge and co-director of the LeadingAge LTSS Center @UMass Boston. “Filling these openings with qualified caregivers depends on our ability to professionalize the direct caregiver workforce.”

The report laid out six strategies:

1. Expand the pipeline of potential caregivers by recruiting nontraditional workers to the LTSS field and changing immigration policy to expand the potential labor pool for jobs in the LTSS field.
2. Enhance education and training, both initial and ongoing, so professional caregivers will feel well-prepared to carry out increasingly complex care tasks, and so nursing homes, assisted living communities, home care organizations, consumers, and their families will have confidence in those caregivers. States should identify competencies that direct care professionals must demonstrate, support the development of training that addresses those competencies, and establish public/private partnerships to invest in relevant, high-quality training and education.
3. Facilitate career advancement so caregivers can grow into meaningful LTSS careers that offer them a variety of opportunities, including career pathways that allow them to become condition-specific specialists, take on advanced caregiving roles, be accepted as valued members of integrated care teams, or perform a full range of health maintenance tasks under the supervision of a registered nurse. Direct care professionals should also have access to career ladders that offer opportunities beyond the traditional nursing path, including careers in social work, therapy, and management positions that use their relationship skills.
4. Increase compensation so direct care professionals can earn at least a living wage. This level of compensation would provide caregivers with enhanced financial security while also reducing turnover and staffing shortages at aging services organizations, boosting productivity, enhancing quality of care, and increasing overall economic growth in communities where direct care professionals live.
5. Prepare universal workers who could become direct care professionals in nursing homes, assisted living communities, and home and community-based settings. This would involve identifying a core set of competencies at the federal level that aides, regardless of setting, could master and demonstrate. These “universal workers” would then have the flexibility to work across settings and even across state boundaries.
6. Reform the LTSS financing system by exploring the use of social insurance approaches to financing LTSS and using insurance-based dollars to provide additional and more consistent funding for LTSS and to help ensure that the LTSS workforce receives adequate compensation.

LeadingAge maintains a short- and mid-range federal policy and advocacy agenda that is detailed in its 2021 Policy Priorities under Workforce.

We represent more than 5,000 nonprofit aging services providers and other mission-minded organizations that touch millions of lives every day. Alongside our members and 38 state partners, we use applied research, advocacy, education, and community-building to make America a better place to grow old. Our membership, which now includes the providers of the Visiting Nurse Associations of America, encompasses the continuum of services for people as they age, including those with disabilities. We bring together the most inventive minds in the field to lead and innovate solutions that support older adults wherever they call home. For more information visit leadingage.org.

About LeadingAge LTSS Center @UMass Boston: The LeadingAge LTSS Center @UMass Boston conducts research to help our nation address the challenges and seize the opportunities associated with a growing older population. LeadingAge and the University of Massachusetts Boston established the LTSS Center in 2017. We strive to conduct studies and evaluations that will serve as a foundation for government and provider action to improve quality of care and quality of life for the most vulnerable older Americans. The LTSS Center maintains offices in Washington DC and Boston, MA. For more information, visit LTSSCenter.org.