Feasibility of Identifying Long-term Care Workforce Shortage Areas

HRSA has published projections of demand and supply of numerous professions. Several years ago, the Government Accountability Office examined the lack of projections for front-line direct-care workers and requested that HRSA develop such projections. Creating these projections is conceptually challenging due to the lack of licensure or certification for most direct-care occupations, lack of common definitions across data sources, and the frequent movements of workers between employment sectors.

The direct care workforce currently comprises about 4.6 million workers, including nearly 2.4 million home care workers. This includes over 730,000 workers employed in residential care homes, about 560,000 nursing assistants in nursing homes, and nearly 900,000 workers in other settings. From 2018 to 2028, the long-term care sector will need to fill 8.2 million job openings in direct care. This includes a projection of 1.3 million new jobs to meet rising demand and 6.9 million replacement workers. In home care specifically, 4.5 million more workers will be needed as the U.S. population ages and aging-in-place demand increases.

Long-term care delivery organizations are reporting direct worker shortages in all settings, including nursing homes, home care, and assisted living. In addition, shortages of geriatricians, gero-psychiatrists, and registered nurses with expertise in long-term care have been reported. Shortages appear particularly severe in rural areas. Our recent report on rural personal care aide (PCA) workers found that there are fewer PCAs available in areas where there are higher numbers of people with self-care disabilities. The mismatch between availability of workers to those needing assistance with self-care activities is largest in the South. Regardless of how rural a state is, the most rural parts of a state have the fewest PCAs per person with self-care disabilities.

Current estimates of workforce shortages are generally not reliable because states do not systematically collect the necessary workforce supply data, measures of care need and setting vary, and many workforce databases aggregate data or use different terminology. In addition, there are few analyses that look at region-specific shortages.


Key Questions

  • What strategies can be used to identify regional and occupational shortfalls of the LTC workforce supply?
  • Which occupations could feasibly be included in future forecasting reports based on conceptual approaches to defining demand and supply, and the usefulness of secondary data sources?


For more information, contact Susan Chapman.