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. Among those currently reaching retirement age, more than half (52%) will require LTSS at some point, and for an average of two years. By 2050, the number of individuals using paid LTSS in any setting will likely double from the 13 million who used services in 2000, to 27 million people.  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.

2019 Aging Services Workforce Policy Goals

  • Ensure that sufficient numbers of qualified, mission-driven staff are available and working at all levels of aging services.
  • Increase the ability of aging services providers to recruit and retain qualified staff.
  • Open new opportunities and eliminate barriers to training staff.
  • Develop and strengthen the pipeline of individuals attracted to and motivated to work in aging services.
  • Advance and promote immigration policies that expand the number of available aging services professionals and paraprofessionals.

Legislative Actions

  • Develop a guest worker program. Develop a legislative proposal for a guest worker program in aging services. Meet with stakeholders to better understand guest worker programs and determine the best way to frame a proposal for a program that includes guardrails and protections for workers.
  • Geriatrics workforce legislation. Support reintroduction of legislation that addresses direct care geriatrics workforce, such as the Geriatrics Workforce Improvement Act (S. 2888), Improving Care for Vulnerable Older Citizens through Workforce Advancement Act (HR 3461), Direct Creation, Advancement and Retention of Employment (CARE) Opportunity Act (HR 3778). These bills provide educational and grant opportunities for direct care workers and enhance the profession.
  • GAO study on the workforce crisis. We will work with members of Congress to encourage that they request a study from the GAO on the LTSS workforce crisis, to raise the visibility of the problem and encourage policymakers to consider solutions.
  • Immigration reform. Track and monitor efforts at Immigration reform: Recognizing that nearly a quarter of the nursing home and home care workforce are foreign-born, we support immigration policies that enable all types and levels of LTSS workers to enter the country and work in aging service settings.
  • CNA Training: One lead organizational priority is the reintroduction of the Nursing Home Workforce Quality Act (HR 6986, 115th Congress). This legislation addresses the impact of penalties on nursing home workforce. We led the development of the Nursing Home Workforce Quality Act and will work to have legislation reintroduced in the next Congress. The bill would offer more flexibility in the relationship between nursing home surveys and CNA training programs.

Administrative Actions

  • CMS regulations. We will ensure that CMS regulations and guidance do not impede the ability of providers to recruit and retain staff.
  • HRSA Geriatrics Training. We will work with the Health Resources Services Administration to promote the value of geriatric training.
  • Homeland Security. We will monitor the Department of Homeland Security and other executive branch activities related to immigration that could affect the LTSS workforce.
  • Career ladders and lattices. We will work with the Department of Labor and others to develop and promote career ladder and lattice programs that offer movement and advancement for people in all positions in nursing homes and other provider types.
  • Operation of power lifts. We support the Department of Labor proposed rule allowing 16 and 17-year-olds to operate power lifts. This will make it easier for high school students to work in settings where power lifts are used with residents. When the rule is final, we will work with DoL to ensure it is enforced.

Developmental/Exploratory Actions

  • CMP templates. We are developing a set of templates that members can work with to submit proposals for staffing improvements using Civil Monetary Penalty funds.
  • Housing and transportation solutions. We are planning to explore policy levers in the Departments of Housing and Transportation to address the challenges faced by many members in these areas.
  • Explore creating new grant programs in the Department of Education. We plan to explore grant opportunities that exist or could be created to support training programs in aging awareness and aging services for elementary, high school and community college students. We will seek education stakeholder partnerships in this work.
  • Materials to educate lawmakers on the role immigrants play in delivering LTSS. We will create briefing materials on the important role immigrants play in delivering LTSS (close to a quarter of CNAs, for example, are foreign born). We will aim to tie these materials to immigration proposals, as appropriate.
  • Gain a better understanding of foreign workers. Many members use agencies that bring nurses from the Philippines and certain African countries. We would like to gain a better understanding of the extent of this and some information about how it’s done and how it is working out.