America’s elder care workforce; Who will be there to care?

On July 12, a panel of six experts in the fields of long-term care, patient care, and workforce quality met at Samuel J. Simmons Estates to discuss the elderly workforce, its challenges, and how to improve the quality of services offered to seniors.


The panel included Jessica Nagro, Daniel Wilson, and Amy York. Moderator Steve Dawson, founder of PHI PolicyWorks started the panel strongly: “The need for dignified care is ever growing,” he said. From there, he went on to introduce Generations Magazine— which he recently guest-edited—calling it a leader in the field of aging, by synthesizing research, education, and best-practices.


Mr. Dawson first asked panelists to address the question “who will be there to care?” emphasizing the problem of a diminishing supply and growing need for a larger, more qualified workforce in the field of elder care. He said, “Since we hide away our elders and those with disabilities, it is no surprise that those who work with these populations are hidden away as well.” He then pointed to the fact that many politicians today do not fully comprehend the elder care workforce crisis, even though healthcare and long-term care are concentrated groups with the highest cost to Medicaid and Medicare.


Nagro of the Eldercare Workforce Alliance, a coalition of 31 national organizations dedicated to addressing the immediate and future workforce crisis in caring for an aging America, argued that there is an absence of expertise in gerontology and that there should be more caregivers trained in Gerontology. She then explained how resolving the workforce crises means resolving recruitment, retention, and training for long-term care and direct care. By encouraging more young adults to go into the field of gerontology and by providing support, resources, and training for unpaid family caregivers, we can ensure a stronger elder care workforce moving forward, according to Ms. Nagro.


Wilson of the Paraprofessional Institute (PHI) explained that there is a lack of diversity in the direct care workforce. He went on to discuss how communities of color and minorities have a systemic lack of trust in the medical field. Mr. Wilson agreed that encouraging young people to enter into gerontology would build a better workforce. He suggested that employers should emphasize how everyone is affected by aging by showing how relatives are currently being affected. He concluded by stressing the importance of cross training to ensure qualified treatment for elders with chronic conditions.


York, Executive Director, Eldercare Workforce Alliance. added that providers are slow to incorporate personal care into the personal care model. The data collected in conjunction with Mr. Sinai Hospital proves that this model is cost effective in improving health outcomes. She continued by explaining that their needs to be a cultural shift that illustrates why we need to pay for the work.


Terry Fulmer, President of the John A. Hartford foundation in New York, emphasized how this line of work is daunting—but also exciting and life changing. She went on to explain the importance of a team-based approach to solving problems. She also emphasized the importance of data evidence to know who should be in the room for what questions. In this group approach, it is vitally important to have the patient and direct caregiver leading the discussion so that the entire team understands the desired outcome and then deploy the appropriate resources at the right time. She concluded by stating, “We need to work smart; we are smart people. We need to find ways to alter care for the patient in front of us.”


Robin Stone of LeadingAge spoke next about the vacancies experienced in care. As it stands, most of these vacancies are filled by non-native workers. Stone explained, “This workforce is critical. If we don’t invest in it, we don’t have quality or an economic driver.” She then connected this trend to current immigration policy, stating that 1 in 5 to 1 in 3 direct care workers are born outside of the U.S. This indicates how important eldercare is to the global community. She explained how in other countries elders a revered for their knowledge and experience and how elders are the most important historic demographic worldwide with the fastest growing population of people 85 and older. In order to effectively open long-term care to non-native workers, we first need to understand their countries of origin and their host country cultural beliefs, in order to understand a worker’s level or training and other factors that may influence the quality of care provided. She stressed that America needs to think about ethical treatment and cultural competency as a member of the international community.


Nancy Lundebjerg of the American Geriatric Society held the anchor spot in the panel. She focused on accountability and affordability of physicians. President Obama wrote an article in the Journal of the American Medical Association where he explained the reasoning behind and direct implications of the Affordable Care Act (ACA). Under the ACA, alternative payment models are leading to better care of older adults. However, the article does not ever mention need for competent, skilled workforce. The lack of existing data on the accomplishments of the elder care workforce should be noted in legislative language. Ms. Lundebjerg went on to explain how the ACA needs to create policy changes that make real impact in the elder care workforce. She argued that the $15 million spent on Medicaid a year should ensure deliverable skills in geriatrics.

This panel helped to put in perspective on those working directly with seniors. It highlighted many underrepresented issues in direct care that affect the quality of care provided to seniors.