If there is a healthcare sector with the biggest potential demographic problem, it's long-term care. Not only are the workers aging, but they mainly care for senior citizens, whose numbers are about to explode.
Even before the first of the baby boomers start retiring, which should be around 2010, the industry needs to find more than a quarter-million replacement workers (See chart). After the boomer bulge hits, a threefold increase in nurses, nurses' aides, home health and personal-care workers may be needed by 2050 unless there are striking changes in how care is provided. According to an HHS and U.S. Labor Department report issued in May, an estimated 5.7 million to 6.5 million long-term-care workers will be needed, up from the 1.9 million who supported the industry in 2000.
"The shortage of long-term-care workers, if left unaddressed, will affect all Americans in very personal ways," Labor Secretary Elaine Chao says.
HHS Secretary Tommy Thompson says that while President Bush's New Freedom Initiative is helping develop more and better options for long-term-care services, the industry must build on the efforts already in place with innovative solutions to solve the critical health challenge of staff shortages.
"We need to act now to build the workforce and encourage creative ways to improve long-term-care in homes and communities and long-term-care institutions," Thompson says.
Skilled-nursing providers, which already are grappling with high liability expense levels and other costs added to Medicare and potential Medicaid cuts, are well-aware that delivering better-quality care means depending upon a bigger quantity of workers. Nursing home operators in particular are scrambling to attract and retain staff, and the pressure to act quickly is on.
In the past year, the Centers for Medicare and Medicaid Services has released quality data on nursing homes and, most recently, home health agencies as part of a large-scale effort to provide health information to consumers so they may better compare the quality of healthcare in their area. To ensure quality care, consumer advocates contend that nursing homes must be more fully staffed while nursing home operators argue they can't find and keep enough workers. Certified nursing assistant positions are the highest in demand.
A 2002 survey by the American Health Care Association, which represents nearly 12,000 not-for-profit and for-profit assisted-living, nursing facility and other subacute-care providers, found that 96,000 full-time healthcare workers were needed to fill vacant positions at U.S. nursing homes last year. Nearly 52,000 of the vacancies were for certified nursing assistants. Additionally, 13,900 staff registered nurse and 25,100 licensed practical nurse positions also were estimated to be vacant, according to AHCA researchers. With the exception of CNAs, rural hospital-based nursing units had the lowest vacancy rate-9.6%-across the five nursing job categories examined while urban, freestanding facilities faced the highest vacancy rate at 16.2%. The survey was completed by 6,155 of the nation's 16,317 nursing homes.
"CNAs are the linchpin in the direct-care system because they're the people who bathe, feed, change and turn our patients," AHCA spokesman Jeff Smokler says. "Unfortunately, it's difficult to attract CNAs to the profession and to keep them because it's a hostile environment where there's low pay and little development of career enhancement programs."
Because of the large number of vacancies, CNAs are burdened and face a lack of support and resources.
"You've got people who are working with very little help," Smokler says, adding that the Nurse Reinvestment Act has allocated some funding for training. Smokler says the AHCA is constantly encouraging its members to apply for such grants, and the HHS and the Labor Department are making an effort to assist with necessary funding.
Their joint report emphasized the need to continue training and education efforts for potential long-term-care workers, particularly through the federal Nurse Reinvestment Act. The staffing report also recommended the need to support state and local initiatives to increase recruitment and retention of direct-care workers while diversifying the hiring pool to include older workers, former welfare recipients, military personnel transitioning to civilian life and family caregivers.