The aging of the U.S. population has profound implications for the health care system. The oldest baby boomers first turned 65 in 2011 and are now doing so at an estimated rate of 10,000 per day. Over the next 35 years, the size of the population over age 65 is projected to nearly double, from 43 million to 84 million. The CDC calls the size and share of older adults in the U.S. population “unprecedented in our nation’s history.” We also know that older adults use more health care services than younger people and typically have more complex health issues. For instance, an estimated seventy percent of individuals use some form of long-term care once they turn 65 (at home with paid or informal caregivers or at nursing/assisted living facilities), and use those services for an average of three years.
Yet the preparation of the health care workforce to meet the needs of older adults remains “woefully inadequate.” The fragmented long-term care “system” falls short in addressing the key issues of quality of care and quality of life. A major portion of the services for older adults are provided by direct care workers such as nurse aides and home care workers, about half of whom have a high school diploma or less, who earn on average between $21,000 – $25,000 a year for full-time work, typically receive 75-120 hours of job training, and have high turnover rates.
Is this any basis upon which to achieve health care’s triple aim of improving the experience of care, improving health outcomes, and reducing per capita costs?
Direct care workers serve as the “hands, face, and voice of health care” for millions of Americans and are arguably the most undervalued and underutilized members of the health care team. They provide some simple clinical services plus assistance with bathing, dressing, housekeeping, food preparation, and other daily activities. By virtue of their regular contact with patients, they are well-positioned to observe health condition changes, identify problems, and facilitate communication between the patient and the rest of the healthcare team to improve care.
Yet standard practice and funding models do not encourage the recognition of these workers as productive members of the care team. Obviously, if direct care workers take on additional responsibility, they should receive additional training and education to equip them with the right skills, for which they should subsequently receive increased wages. It would be a virtuous cycle: higher skills, better jobs, better care. There is no shortage of models. In some cases, the direct care workers’ re-imagined role is nested in a larger re-organized system of care with an explicit focus on inter-disciplinary healthcare teams, such as the Green House model or the PACE program. In other cases, the focus is more targeted to increasing the training and skills of home care workers, such as Cooperative Home Care Associates and the SEIU Healthcare NW Training Partnership’s Advanced Home Care Aide Apprenticeship Program.
In future posts, I will delve deeper into how some long-term care providers and training organizations are addressing the challenges of providing health care to an aging population, focusing on those that incorporate an enhanced role and increased training for direct care workers.
The Initiative is a partnership between the Economic Studies program at Brookings and the USC Schaeffer Center for Health Policy & Economics, and aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.