Paraprofessional workers--nursing assistants, home health aides and personal care attendants--are the backbone of the formal long-term care system. These workers provide necessary care and support to millions of elderly people as well as younger people with chronic diseases and disabilities.
As policymakers focus more attention on quality outcomes in long-term care, the need for a prepared, committed and sustainable long-term care workforce has become an increasing priority.
Unprecedented vacancies and high turnover among these workers have affected both home and community-based providers and nursing homes, which have reported turnover rates ranging from 40 percent to over 100 percent annually.
In a national survey conducted in 2000, 42 states reported that nurse aide recruitment and retention were major issues. There is increasing evidence that these recruitment and retention problems are affecting both the quantity and the quality of long-term care services received.
The recent softening of the economy might be expected to take pressure off tight labor markets and make direct care jobs more competitive; however, there is little evidence to support such a trend. The latest national survey of state long-term care workforce recruitment and retention practices, conducted in the first half of 2002, found that the vast majority of states continue to report serious concerns about attracting and retaining direct care workers.
Moreover, shortages of qualified, committed paraprofessionals are likely to worsen. In the coming years, the U.S. will experience a tremendous increase in the size of its elderly population as baby boomers age. At the same time, the number of middle-aged women who have traditionally filled these jobs is not growing fast enough to meet the increased demand for services. The result of these demographic shifts is an emerging "care gap" that could severely curtail our nation's ability to provide long-term care.
Numerous factors contribute to the difficulty in recruiting and retaining direct care workers.
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Wages are generally low and benefits are poor.
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Job preparation, continuing education and training frequently fail to prepare these workers for what they face in caring for people with increasingly complex needs.
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Advancement opportunities are often limited.
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Direct care workers often do not feel valued or respected by their employers and supervisors.
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Despite having more interaction with patients than many other members of the care team, these workers are often excluded from decision-making involving patient care.
Provider and worker organizations, along with many states, have undertaken various initiatives to attract and retain qualified direct care workers. However, very few of these have been evaluated. Credible evidence is needed on how well specific interventions work, either alone or in combination with other interventions, to meet the challenge of getting and keeping quality paraprofessionals.
For a thorough and incisive overview of the challenges facing paraprofessional long-term care workers, be sure to read:
