Press Releases

UCSF HWRC Renewed for Five-Years for Long Term Care Research. New NIH Funding for Dementia Workforce Research.

The UCSF Health Workforce Research Center on Long-Term Care (UCSF HWRC) is a dynamic hub of policy-oriented research

The UCSF Health Workforce Research Center on Long-Term Care has received a five-year renewal from the US Health Resource and Services Administration.

Growing demand for long-term care services, rising LTC costs, new care models, and current and projected shortages of LTC workers create an urgent need for new LTC workforce research and policy development.

Established in 2013, UCSF HWRC is one of nine programs funded by multi-year cooperative agreements with the US National Center for Health Workforce Analysis in the US Bureau of Health Workforce at HRSA.

The UCSF HWRC’s dynamic hub of two dozen faculty and staff seeks to support the health care workforce in meeting the growing long-term care needs of aging Americans and people with disabilities, both at home and in the community. The UCSF HWRC closely examines the health care workforce and helps shape policies to meet expanding LTC needs.

Their research includes the workforce in nursing homes, home health care, adult day care, community-based settings, and home settings, and includes all LTC occupations. They conduct research on LTC labor market developments, outcomes and impacts of employment and training policies, and report on LTC labor trends.

With regularly produced publications, the UCSF HWRC actively engages with national, regional, state, and local employment and training organizations, as well as professional associations, to disseminate findings to the national and local media. They also provide data and information for federal and state agencies, practice organizations, and policy leaders to inform the development of workforce policy.

UCSF HWRC to Develop NIH-funded AWARD Network for Dementia Workforce Research

UCSF HWRC has also received a grant from the National Institutes of Health to establish the AWARD (Advancing Workforce Analysis and Research for Dementia) Network to advance research on the direct care workforce and other health professionals that serve people living with dementia through programs and activities to create a strong community of researchers.

More than six million people live with neurodegenerative diseases in the United States, receiving care and support from both unpaid care partners and paid workers. The direct care workforce – which includes personal care aides, nursing assistants, and home health aides – is the largest occupation serving people living with dementia, but there is little research to guide evaluation and refinement of workforce-related policies and programs that affect their supply, demand, training, skills, and collaboration with other health care professionals.

There also is an urgent need to identify effective approaches to support direct care workers in their interface with an increasingly diverse population of people living with dementia and with other health care professionals.

The AWARD Network will offer monthly webinars, host annual meetings in conjunction with national conferences, hold summer training institutes, and offer pilot and internship funds.

Those interested in participating in the AWARD Network can sign up through an online application!

Subscribe to the HWRC newsletter for more information.

Study Finds Few COVID-Displaced Workers Re-Employed in Direct Care

A new report finds that few workers displaced by COVID-19 from occupations with similar skills as required in direct care jobs filled job openings in direct care.

NEW YORK — A new study by PHI and the Health Workforce Research Center on Long-Term Care at the University of California, San Francisco finds that many COVID-displaced workers were in occupations with similar entry-level requirements as direct care, but that few took jobs in direct care, where there continues to be a worsening staffing shortage.

These results are detailed in a new report, Workforce Displacement and Re-Employment During the COVID-19 Pandemic: Implications for Direct Care Workforce Recruitment and Retention, which examines workforce displacement and re-entry during the COVID-19 pandemic among direct care workers and workers from similar entry-level occupations, such as food preparation and serving, office and administrative support, and others.

The purpose of this study was to understand whether and how new workers were recruited into direct care jobs during this crisis, which has implications for how the long-term care field could fill job openings in the future.

Direct care workers, defined as home care workers, residential care aides, and nursing assistants, ensure that older adults and people with disabilities have the support they need across care settings. These jobs often have inadequate compensation, limited training and advancement opportunities, long-standing gender and racial inequities, and a general lack of recognition and support.

According to PHI, the nation’s leading expert on the direct care workforce, long-term care employers will need to fill 7.4 million job openings in direct care from 2019 to 2029, including 1.3 million new jobs to meet rising demand, and another 6.1 million job openings to replace workers who leave the labor force or transfer to new occupations, often in search of higher wages or safer working conditions.

“This research provides new insights on a long-standing question that has become even more urgent in the last two years: how do we recruit more workers into the direct care workforce to meet growing demand and avoid future tragedies?” said Jodi M. Sturgeon, president of PHI.

Joanne Spetz, associate director for research at the Health Workforce Research Center on Long-Term Care at the University of California, San Francisco and one of the three co-authors of this report, added, “The fact that few workers who lost jobs during the pandemic moved into open direct care jobs highlights the need to improve direct care jobs so they attract well-skilled and dedicated people to care for people who need their services.”

KEY FINDINGS

The study examines three primary questions, starting with: How many direct care workers and workers from other occupations with similar entry-level requirements became unemployed during the first three months of the COVID-19 pandemic?

The second question explored the extent the which the knowledge, skills, work activities, and work context of displaced workers’ previous occupations were aligned with those of the three direct care occupations.

And, the third question asked: How many displaced workers re-entered the workforce (including into direct care jobs) within the following year, and from which previous occupations?

Data from the U.S. Census Bureau’s Current Population Survey and the Occupational Information Network [O*NET] were used to address these questions.

According to Workforce Displacement and Re-Employment During the COVID-19 Pandemic:

• 13.7 million U.S. workers were displaced from occupations with similar entry-level requirements to direct care during the first three months of COVID-19 in 2020.
• Sixty-seven percent of COVID-displaced workers (9.2 million workers) were displaced from five major occupational groups: food preparation and serving-related occupations (3.1 million workers), office and administrative support occupations (2 million workers), sales and related occupations (1.6 million workers), transportation and material moving occupations (1.6 million workers), and production occupations (1 million workers).
• One year later, in early 2021, 66 percent of those COVID-displaced workers (9.1 million workers) had re-entered the workforce, leaving 4.6 million displaced workers still out of work.
• Two occupational groups similar to direct care had large numbers of displaced workers who did not re-enter the workforce: food service and serving occupations (1.9 million long-term displaced workers) and office and administrative occupations (1.2 million long-term displaced workers).
• Across these occupational groups, women and people of color were more likely to be displaced and less likely to re-enter the workforce.
• Four percent of direct care workers were displaced during the second quarter of 2020, and an immeasurably small number of displaced workers (from direct care or any other occupation) were re-employed into direct care.
• Overall, re-employed workers tended to earn higher wages and were more likely to work full time than direct care workers.

"It's clear from this study that the direct care job should be made more attractive to workers, and we all must find new ways to recruit specific populations into these jobs," said Stephen McCall, data and policy analyst at PHI and a co-author of the report.

MOVING FORWARD 

The report lays out various opportunities to strengthen the direct care workforce during and beyond the COVID-19 pandemic, including raising compensation for direct care workers and improving the overall quality of these jobs. According to the report’s authors, poor job quality in direct care helps explain why so few COVID-displaced workers chose to enter this workforce.

Other recommendations from the report include developing tailored recruitment strategies that reach job candidates from occupations similar to direct care, creating workforce supports specific to people of color and people with family caregiving responsibilities, and better supporting new hires as they transition into direct care roles, to address the problem that many direct care workers leave their jobs within the first few months of employment.

"The overarching lesson from this report is our country’s leaders will need to transform the direct care workforce to ensure that employers can fill these jobs—now and in the decade ahead," said Kezia Scales, director of policy research at PHI and one of the report’s co-authors.

Read the full report.

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5 a.m. PT / 8 a.m. ET, Monday, Sept. 6, 2021

Media Contact: Laura Kurtzman (415) 502-6397
[email protected] | @UCSF

California Faces Short-Term Nursing Shortage from COVID-19 Retirements

Report Calls upon Employers and Policymakers to Develop Career Paths for New Graduates and Engage Late-Career RNs to Retain State’s Nursing Talent

California will face a significant shortfall of registered nurses over the next five years due to long-term trends that have been exacerbated by the pandemic, according to a new report by the UCSF Health Workforce Research Center on Long-Term Care.

The authors estimate a current shortage of 40,567 full-time equivalent RNs, a 13.6 percent gap, that is projected to persist until 2026, according to an analysis of preliminary data from the 2020 Survey of California Registered Nurses and final data from the 2019-20 Annual RN Schools Survey.

At a time when hospitals nationwide are facing challenges in filling nursing positions, the study found that many older registered nurses in California have left the field and a large number plan on retiring or quitting within the next two years. Meanwhile unemployment among younger RNs in California has increased.

“The pandemic is accelerating a broad trend that has been building for some time,” said Joanne Spetz, PhD, co-author of the report and director of the UCSF Philip R. Lee Institute for Health Policy Studies (PRL-IHPS). “To address this, employers need to retain older RNs, while developing career paths for new graduates. They also need to rapidly develop and implement strategies to mitigate the potential harm of nurse shortages over the next five years.”

California currently has more than 350,000 registered nurses employed in its hospitals, clinics and other facilities, as well as more than 450,000 licensed nurses. California nurses make up nearly 12 percent of all nurses employed nationwide. Among employed RNs in California, an estimated 30 percent are over age 55.

In 2020, 26 percent of registered nurses between the ages of 55 and 64 said they plan to leave the field in the next two years, up from 12 percent in 2018. The authors said this was most likely from burnout and the need to reduce COVID-19 exposure to at-risk family members.

At the same time, employers have been reluctant to hire less experienced RNs, possibly because of the difficulty in onboarding them during the pandemic. Demand for nurses was also reduced in some regions because of limits on elective surgeries and in-person ambulatory care.

The report, released on Sept. 6, 2021, estimates that 8,500 California RNs were seeking employment in late 2020, which would fill about 20 percent of the current shortfall.

California is also producing fewer nurses. Public registered nursing education programs, including city colleges and the California state system, had to decrease enrollments, skip cohorts and reduce class sizes during the pandemic, in part because of their inability to place students in clinical environments.

“These programs didn’t have the resources to pivot online or to distance within classrooms as a private school can,” Spetz said. “Policymakers need to support public nursing education programs to ensure an ongoing pipeline of nurses into the health care system.”

Fortunately, there is a record-breaking interest in the nursing profession, Spetz said. RN education enrollments are projected to surpass pre-pandemic levels during the 2022-23 academic year.

Spetz said much can also be done to retain older nurses, for example by offering them alternative roles as mentors.

“Employers need to be really thoughtful about long-term workforce development,” Spetz said. As nurses exit the workforce at a more rapid rate, employers will need to onboard new RNs. “Can you address older RNs’ burnout and keep them in the workplace part-time to help onboard the new grads?”

Co-authors of the report include Lela Chu and Lisel Blash, both of UCSF.

The UCSF Health Workforce Research Center on Long-Term Care (UCSF HWRC) is a dynamic hub of policy-oriented research and investigation, established through support from the National Center for Health Workforce Analysis in the US Bureau of Health Workforce.

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes UCSF Health, which comprises three top-ranked hospitals, as well as affiliations throughout the Bay Area. Learn more at https://www.ucsf.edu, or see our Fact Sheet.

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UCSF STUDY PROJECTS NEED FOR 2.5 MILLION MORE LONG-TERM CARE WORKERS BY 2030

At least two and a half million more workers will be needed to provide long-term care to older people in the United States between now and 2030, according to a study by UC San Francisco researchers published in the June 2015 issue of Health Affairs.

The study authors predict that there will be little effect on this demand for new workers even if long-term care use among different racial and ethnic groups changes significantly or if there is a major shift from institutional care to home-based care.

“Even if 20 percent of elderly patients move out of nursing homes into home health care, which would be huge change, the projected increase in demand for long-term care workers would only drop from 79 percent to 74 percent,” said lead author Joanne Spetz, PhD, professor at the UCSF Phillip R. Lee Institute for Health Policy Studies and associate director for research strategy at the UCSF Center for the Health Professions. “Filling these jobs will be a big challenge under any scenario.”

The authors recommend that policy makers and educators “redouble” efforts to recruit, train and maintain long-term care workers, especially home health and personal care aides.

They note that 20 percent of Americans will be 65 years or older by 2030, and that 19 million adults will need long-term care services by 2050, up from 8 million in 2000.

In the study, the authors analyzed current long-term care usage patterns by age, gender and race, and projected those patterns into the future. They then created a series of alternative scenarios in which different racial and ethnic groups increased or decreased their current usage, and in which all groups shifted from nursing home care to home health care or assisted living.

“In the end, to our surprise, none of these changes made a substantial difference in the projected demand for long-term care workers,” said Spetz. “We’re looking at a big increase in jobs, no matter how the demographics play out.”

The occupations predicted to grow the most over the next 15 years are counselors and social workers at 94 percent, community and social service workers at 93 percent, and home health and personal care aides at 88 percent.

“In terms of sheer numbers, the greatest need is going to be for home health and personal care aides, with well over one million additional jobs by 2030,” said Spetz. “The challenge is that these are currently very low-paid, high-turnover, entry-level positions. A lot of people in these jobs are living in poverty while working full time. We have to figure out how to make them sustainable.”

Only a few states have any kind of training requirement for home health or personal care aides, noted Spetz. In addition, she said, “there is not much evidence that these jobs are ladders to higher-skilled health occupations. Unless the system begins to offer these workers a pathway for moving into nursing or case management, for example, these jobs will continue to be a revolving door to unemployment and jobs in other low-wage industries.”

Co-authors of the study are Laura Trupin, MPH, Timothy Bates, MPP, and Janet M. Coffman, PhD, of UCSF.

The study was supported by funds from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

UCSF is the nation's leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospital San Francisco. Please visit www.ucsf.edu.

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Long-Term Care Industry Growing, But Workforce Departures Outpacing New Hires

The long-term care (LTC) industry expects substantial growth in employment opportunities to meet growing health care demand. But, the rate of exit from long-term care jobs is outpacing the rate of entry, according to a new report issued by the UCSF Health Workforce Research Center on Long-Term Care (HWRC).

Researchers recommend future investment in training and education to increase recruitment and retention of workers to meet the burgeoning demand from aging Baby Boomers.

The long-term care industry experienced substantial job growth in the past decade, a trend that will continue into the next decade and beyond, reports the U.S. Bureau of Labor Statistics. In the HWRC report “Entry and Exit of Workers in Long-Term Care,” LTC employs a high share of low-skilled workers, and the rate of leaving LTC jobs is now outpacing the rate of entry into the industry.

In anticipation of growing demand for LTC from aging Baby Boomers, workforce planners are concerned about ensuring an adequate pipeline of appropriately trained workers for LTC jobs.

“This is especially concerning, as most people who left the LTC workforce – particularly those with lower skill levels – found themselves unemployed or out of the labor force entirely, and they also reported higher rates of work disability and poverty,” said study co-author Bianca Frogner, PhD, of the University of Washington School of Medicine.

“We don’t know whether the elevated rate of transition for LTC workers provides opportunities to obtain higher-paying jobs or develop new skills, or if they increase the likelihood that these workers will live in poverty,” said co-author Joanne Spetz, PhD, professor in the UCSF Philip R. Lee Institute for Health Policy Studies and HWRC director.

Among the report’s findings are that as of 2013, nearly all LTC workers were women, and minorities represented about 40 percent of the workforce, which was higher than the national average of 21 percent of the overall U.S. labor force.

The authors propose that future research explore the longer-term employment paths of LTC workers and recommend policymakers consider investments in education and training to ensure an adequately trained workforce that remains in the LTC industry.

The report is available at http://healthworkforce.ucsf.edu/publication/entry-and-exit-workers-long-....

and was funded by the U.S. National Center for Health Workforce Analysis, a program of the Health Resources and Services Administration. This is the second in a series of reports to be issued by the HWRC, which was created to examine the supply, demand, distribution and capacity of the health care workforce to meet the needs of older adults and persons with disabilities.

About UC San Francisco

UCSF is the nation's leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospital San Francisco. Please visit www.ucsf.edu

About the University of Washington

The University of Washington is one of the world’s preeminent public universities. Founded in 1946, the University of Washington School of Medicine is a regional resource for Washington, Wyoming, Alaska, Montana and Idaho – the WWAMI states. It is recognized for excellence in training primary-care physicians and for advancing medical knowledge through scientific research. UW School of Medicine is consistently recognized as one of the nation's top providers of instruction. In 2013, U.S. News & World Report ranked UW No. 1 in the areas of primary care, family medicine and rural medicine. Please visit www.uwmedicine.org

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State Training Standards for Personal Care Aides Inadequate and Inconsistent

According to reports issued by UCSF Health Workforce Research Center on Long-Term Care. Encourage states to improve training requirements, cite seven “leader states” as examples.

The vast majority of states have extremely weak or non-existent standards for training personal care aides (PCAs), while a few states do better, according to the authors of two complementary research reports issued by the UCSF Health Workforce Research Center on Long-Term Care (HWRC).

Personal care aides provide the majority of care at home for older Americans and persons with disabilities, according to the US Bureau of Labor Statistics.

A report titled “The National Landscape of Personal Care Aide Training Standards” concluded that less than half of states (45 percent) have one or more programs with no PCA training requirements and 22 percent have no PCA training requirements at all. Only four states have implemented rigorous PCA training standards that are uniform across all Medicaid-funded programs.

Authors Abby Marquand, MPH, director of Policy Research at PHI (formerly the Paraprofessional Healthcare Institute) and Susan A. Chapman, PhD, RN, FAAN, co-director of the HWRC, said that most state training programs for PCAs are “undeveloped” compared with standards for certified home health aides and nursing assistants.

“With projected demand for PCAs skyrocketing and states reporting difficulty attracting and retaining enough high-quality workers, we are fast approaching a crisis,” said Marquand. “We believe that improving training standards is a critical first step in meeting the coming demand.”

According to the report, the number of people in the United States needing personal assistance services is expected to grow from 13 million in 2000 to 27 million by 2050. Demographers estimate that by 2020, 64 million Americans will be eligible for Medicare ― one third more than today.

As defined in the reports, PCAs provide essential supports and services that enable older adults and people with disabilities to remain living safely at home and engaged with their communities. These include paramedical services such as oral medication administration and dressing changes; assistance with activities of daily living, including bathing, dressing, preparing meals and shopping; and support for community participation.

HWRC Director Joanne Spetz, PhD, FAAN, observed, “The need for PCAs is predicted to increase almost 50 percent between now and 2022. For the sake of these indispensable health care workers as well as the well-being of the people they care for, it is important that states bring PCA training standards up to some level of rigor and uniformity.”

A companion research brief, “Leader States in Personal Care Aide Training Standards,” describes the approaches of seven “leader states” ­ Alaska, Arizona, Arkansas, Idaho, Minnesota, Virginia and Washington ­ that Marquand and Chapman credit as having achieved rigor and consistency in their PCA training programs.

“There is no ‘one size fits all’ approach to improving standards,” said Chapman. “All of these states provide different examples for how to begin to go about this process.”

“The diverse routes taken by the seven leader states may prove useful starting points for those states that are developing or reforming their standards,” concluded Marquand.

The reports are available at http://healthworkforce.ucsf.edu/news/read-our-first-reports and were funded by the U.S. National Center for Health Workforce Analysis.

They are the inaugural reports issued by the HWRC, which was created to examine the supply, demand, distribution and capacity of the health care workforce to meet the needs of older adults and persons with disabilities.

PHI works to transform eldercare and disability services, fostering dignity, respect, and independence―for all who receive care, and all who provide it. The nation's leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality care.

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