Workforce Issues in Long-Term Care

The concept of a long-term care workforce is of relatively recent origin. Throughout much of the history of the United States, only a small proportion of the population was old and infirm, and dependent aged persons were almost always cared for by family members. Institutional care was virtually unknown, with the exception of almshouses for the truly isolated and destitute. The professional provision of long-term care as it is known today began with the passage of the Social Security Act in 1935 and solidified with the advent of Medicare and Medicaid in 1965 (Olson).

Since that time, the enormous growth in the number of nursing homes, as well as in home care and community-based services, has produced a large number of individuals who care for older persons who are chronically ill and disabled. The care recipients require assistance for months or years and are very unlikely to return to totally independent living. Although long-term care workers have become essential to society, developments since the 1990s have made work in such settings increasingly challenging. There is now considerable concern, both at the public and at the personal level, about the supply and the caring capacity of long-term care workers.