All stakeholders — providers, workers, other advocates and state and plan officials — must take a holistic approach to finding solutions to workforce challenges in long-term care rather than siloing discussions into institution- or population-based workforce sectors, LeadingAge Senior Vice President of Research Robyn Stone, DrPH, said Tuesday during a panel discussion.
“Nursing homes, adult day providers, home care and assisted living providers are competing with each other for the same workers,” she said. “It’s an untenable situation.”
A holistic approach, Stone said, starts with bringing together government, educational and data agencies to understand the supply and demand needs of the direct care workforce and then designing implementation strategies to stress quality and sustainability.
She was part of a virtual panel discussion, hosted by the Long-Term Quality Alliance, about best practices and areas for stakeholder collaboration related to this issue. The need exists to think differently about compensation, competency, skill development and the value placed on the direct care workforce, they said.
Move toward a living wage
The long-term care sector, Stone said, should think more broadly about moving toward a living wage across the board, rather than thinking about compensation for a particular staff caring for a specific population.
“We have a lot of [American Rescue Plan Act] funds mulling around in states,” she said. “There is a lot of short-term-focusing on pumping up the workforce to increase pipelines and recruitment. At the end of the day, we need a quality workforce that is retained and grows.”
National Alliance for Direct Support Professionals CEO and President Joe Macbeth agreed, saying that the key is to elevate the profession by changing the narrative on how the direct care workforce is defined.
“This is a complex job that requires a high level of skill, a high level of acuity, a high level of responsibility, independent decision making and judgment, often without adequate supervision,” he said. “We need to talk about who they are and what they do in a completely different way.”
It starts with training
Elevating the direct care workforce, the panelists said, should begin with basic universal staff training to prepare people to perform jobs in all settings.
Core competencies should be created at the federal level so that they are standardized and equitable across states and across workers caring for different populations, Stone said. Tying money to competencies is necessary in order for society and workers themselves to see direct care workers as professionals, she added.
“If we’re able to demonstrate professional competencies — just like in nursing and social work and other professions — you pay for them,” Stone said. “Without that kind of a base, I think we’ve been able to completely undervalue this workforce, [to] call them unskilled and get away with it.”
Right now, training requirements often vary by state, LeadingAge Senior Director of Workforce Research and Development Natasha Bryant said. Standardizing training and improving the workforce, she added, would strengthen the pipeline and attract people to long-term care.
Bryant advocated for condition-specific specialists focusing on areas such as dementia care, behavioral health and pain management and tying in advanced training, new job descriptions and higher wages for additional responsibilities.
Many long-term care workers don’t have opportunities for further education or advanced degrees, only receiving on-the-job training, AARP Public Policy Institute Director of LTSS Carrie Blakeway Amero said.
“Society has an obligation to invest more in workers and make sure it’s not bare-minimum adequate but robust, for the benefit of the people receiving [long-term services and supports] but also for the workers themselves, so they have opportunities for career advancement and development,” she said.
