Workforce Issues in Long-Term Care

At the beginning of the twenty-first century, recruitment and retention of a committed long-term care workforce has become a serious challenge, and one that is likely to persist for several decades. There are a number of reasons for increasing difficulties in this area.

First, the explosive growth in the elderly population has created an enormous need for long-term care workers. The population age sixty-five and older will expand by eighteen million persons by 2010, from 35.7 million to 53.9 million. The number of elderly persons with functional disabilities will increase in that time by 1.6 million, from 8.8 million to 10.4 million (Congressional Budget Office). The growth in the latter group is particularly critical, because it constitutes the demand for long-term care. Much of the anticipated need for additional frontline workers is due to this increase.

Second, the long-term care population is becoming more disabled and more complex to care for. The emphasis throughout the 1990s on transferring elderly people from acute to long-term care settings has had a major impact on nursing homes in particular. This trend toward earlier discharge means that more residents have acute illnesses from which they have not completely recovered at the time they are transferred to long-term care facilities. One of the results of this trend is that nursing homes are now using technologies that previously were used only in hospitals. The burden of care for this increasingly impaired population falls on long-term care workers.

Third, the labor force as a whole is growing at a slower rate than the elderly population that needs care. When one examines the pool of persons most likely to become long-term care workers, there are good reasons to expect a continuing shortfall in the caregiving workforce. Women are the dominant providers in health care, representing 78 percent of health care positions in the United States in 2000. Most critical, 93 percent of paraprofessionals and 95 percent of nurses are women (Franks and Dawson). Therefore, a meaningful statistic is the relationship between the size of the elderly population (who are likely to need care) and the number of ‘‘traditional’’ caregivers—that is, working-age women. Nationally, this ‘‘caregiver ratio’’ shows a striking trend. In 2001, census data indicate that the caregiver ratio is fifty-eight elderly persons to every one hundred females age twenty-five to fifty-four. In 2025, the ratio will be slightly over ninety-nine elderly persons to one hundred females age twenty-five to fifty-four. This is very likely to lead to increased shortages of long-term care workers (U.S. Bureau of the Census).

Fourth, restrictive immigration policies reduce the labor pool. New immigrants are relied upon heavily in urban areas to fill frontline long-term care positions. However, employment-based legal immigration is largely limited to skilled workers; unskilled workers can wait years for work permits. Coupled with the shortage of younger workers, restricted immigration will result in a limited supply of new workers.