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Workforce Demand and Supply
Personal Care and Home Care Workforce
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Nursing Homes
Behavioral Health
Palliative Care
Current Projects
Changes in Caregiving During the COVID-19 Pandemic
The aging of the U.S. population will lead to greater demand for assistance with activities of daily living. Much of this support is provided by family members, but changing family sizes and locations have raised concern that those needing support will be increasingly reliant on non-family assistance, including paid caregivers. During the COVID-19 pandemic, the dynamics of family support for people living with disabilities were disrupted due to shelter-in-place orders. Read more...
Health and Health Care Experiences of Direct Care Workers
Direct care workers — who include 4.6 million personal care aides, home health aides, and nursing assistants — support the health and wellbeing of older adults and people with disabilities across long-term care settings. However, as primarily low-income women of color and immigrants, these workers are likely to experience considerable health disparities themselves. As one example, less than half of all direct care workers (46%) have employer-sponsored health insurance, and 15% have no coverage. Read more...
Palliative Care Staffing and Services in Long-Term Acute Care Hospitals
Each year, long-term acute care hospitals (LTACHs) care for over 100,000 individuals with complex and serious illness requiring prolonged inpatient care for weeks or months following a short stay hospitalization. Patients cared for in LTACHs are typically older, disproportionately from underserved backgrounds (e.g., Black and dual Medicare-Medicaid enrolled), and have substantial multimorbidity. Read more…
Characteristics of Clinician Providers in Nursing Facilities and the Home
The US adult population is aging while increasing in clinical complexity, which will exacerbate an already strained health care workforce. There are long-standing concerns around ensuring an adequate workforce in nursing facilities. Workforce challenges associated with nursing facilities are multi-pronged – both the supply and training of the workforce may be inadequate. Read more…
The Tribal Home Care Workforce Providing Culturally Informed Care
The COVID-19 pandemic revealed significant problems in occupational and consumer safety in systems that house and provide LTSS. Long-standing problems in systems that provide health care services to tribal nations were exacerbated and emphasized. While the COVID-19 pandemic exposed and magnified the deficits American Indian/Alaska Native (AI/AN) populations experience with elder care, this issue is long-standing and persists during non-emergency periods. Read more...
Licensed Nurse Employment in Long-Term Care: An Update
Nursing is the largest health profession in the United States and nurses play a major role providing care in a wide variety of health care settings. There are more than 3.8 million registered nurses (RNs) licensed in the United States, including more than 234,000 nurse practitioners (NPs), 81% of whom are employed in nursing. The U.S. Bureau of Labor Statistics estimates that demand for RNs will grow 14.8% between 2016 and 2026, with 7% growth in nursing homes and residential care facilities and 48.6% growth in home health services. Read more...
Primary Care Providers’ Perspectives on Process and Outcome Measures Related to Care for People with Alzheimer’s Disease and Related Dementia
More than 7 million people live with Alzheimer’s disease and related dementias (ADRD) in the United States, a number that is rapidly growing. Primary care providers (PCPs) are the first and, in some cases, only point of contact for most patients with suspected and confirmed ADRD, yet numerous studies have found persistent barriers to provision of high-quality primary care for this population. Read more...
Personal Care Aide Training Requirements: An Update
Personal care aides (PCAs) provide essential daily assistance to older adults and people with disabilities in private homes and community settings across the United States. This workforce is large and growing rapidly to meet escalating demand for home and community-based services (HCBS). Together, PCAs and home health aides (HHAs) comprise the second largest workforce in the country, and the U.S. Bureau of Labor Statistics projects that the U.S. will add 924,000 new HHA and PCA jobs between 2021 and 2031, which is more job growth than in any other occupation. Read more...
Staffing and Services in Residential Care Facilities
Residential care communities (RCCs), which are also known as assisted living facilities and residential care facilities, provide long-term services and supports in a residential setting. They provide care to both older and younger adults who need assistance due to disability or cognitive impairment. In 2016, more than 800,000 people lived in nearly 29,000 RCCs in the United States, and 41.9% of them were diagnosed with dementia. Read more...
Nursing Home Staffing Instability During and After the Acute Phase of the COVID-19 Pandemic
Nursing homes are essential in providing care to millions of Americans, with staffing being a crucial factor in providing high quality care. Adequate staffing levels, typically measured as hours per resident day (HPRD) and often measured separately for registered nurses (RNs) and for certified nursing assistants (CNAs), are vital for nursing home quality. Prior studies have shown that staffing instability is associated with poor health outcomes and adds to poor outcomes above and beyond low average staffing and turnover. The importance of staffing is widely recognized and is increasingly becoming a policy focus. Read more...
Workforce Demand and Supply
Sources of New Workers and Job Mobility in Long-Term Care
This project analyzed job mobility of long-term care workers, specifically examining wage differences that appear between entry and exit from this field. The analysis identified the occupations and industries from which long-term care workers are drawn, and the fields that workers enter if they leave LTC. Read more...
Trends in Long-Term Care Service Use and Workforce Demand Predictions
This project extended existing prediction models that forecast demand for long-term care, to understand how projected demand for different types of LTC services in the future translates to the need for LTC workers. Read more...
Time Use of Long-Term Care Workforce
Whether workers exit or stay in the labor force depends not only on compensation and work satisfaction, but also on factors outside of the workplace: their ability to develop new skills, take part in social activities, engage in hobbies, and have time for leisure activities. Read more...
The Racial and Ethnic Diversity of the Long-Term Care Workforce
The proportion of the US population aged 65 and older that is non-white is projected to increase from 20% to 27% between 2010 and 2030. This increasing racial/ethnic diversity raises questions about the ability of the long-term care workforce to meet their needs. This project will provide information about the extent to which the racial/ethnic diversity of the LTC workforce mirrors the racial/ethnic diversity of the population to help HRSA identify occupations that may benefit from investment of resources to encourage more racial/ethnic minorities to complete education programs. Read more...
Employer Demand for Physician Assistants and Nurse Practitioners in Long-Term Care Settings
By 2030, people aged 65 and older are projected to account for 20% percent of the US population. One solution to meet the demand for health care professionals with expertise in long-term care (LTC) may be to employ more nurse practitioners (NPs) and/or physician assistants (PAs) in LTC settings. To our knowledge, this will be the first study to evaluate the national job market for PAs and NPs in LTC settings. Understanding LTC demand for PAs and NPs will help to guide HRSA’s investment in LTC education versus other high-demand fields. The study will be conducted in partnership with Duke University. Read more...
Rapid Assessment of Changes in Registered Nurse Employment and Demand during the COVID-19 Pandemic
During the first six months of the COVID-19 pandemic, numerous issues about the nursing workforce were reported, including nursing shortages amidst potential surges and the inability of nursing students to continue their clinical education due to pandemic-related concerns. Read more...
Characteristics of Multiple Job Holders in Long-term Care
Many health care workers in long-term care (LTC) settings hold multiple jobs. The COVID-19 pandemic added a new set of concerns to this employment pattern, as movements of workers between care settings can increase exposure to COVID-19 for frail older people receiving support, and also increases workers’ risk of exposure and stress. We examined rates of multiple job holding and characteristics of multiple job holders in the LTC workforce prior to the pandemic to understand rates of multiple job holding and how this is associated with job title, race/ethnicity, gender, and household characteristics. Read more...
Trends in Contract Nursing Assistant Staffing and Quality of Care
Certified nursing assistants (CNAs) play a critical role in ensuring quality care for nursing home residents. They provide twice as many hours of hands-on care per resident per day than licensed practical nurses and registered nurses combined, and the amount of care provided by CNAs is positively associated with improved quality outcomes for residents. During the COVID-19 pandemic, higher CNA staffing levels have been associated with a reduced likelihood of COVID-19 outbreaks and deaths among residents. Read more…
The Tribal Home Care Workforce Providing Culturally Informed Care
The COVID-19 pandemic revealed significant problems in occupational and consumer safety in systems that house and provide LTSS. Long-standing problems in systems that provide health care services to tribal nations were exacerbated and emphasized. While the COVID-19 pandemic exposed and magnified the deficits American Indian/Alaska Native (AI/AN) populations experience with elder care, this issue is long-standing and persists during non-emergency periods. Read more...
In the trenches: Front-line workers’ burnout experiences in long-term care settings in the COVID-19 pandemic
Burnout is a well-known and longtime issue originating from various reasons leading to negative consequences such as depression and anxiety among the workers and lower quality of care in both acute and long-term care. Read more...
Licensed Nurse Employment in Long-Term Care: An Update
Nursing is the largest health profession in the United States and nurses play a major role providing care in a wide variety of health care settings. There are more than 3.8 million registered nurses (RNs) licensed in the United States, including more than 234,000 nurse practitioners (NPs), 81% of whom are employed in nursing. The U.S. Bureau of Labor Statistics estimates that demand for RNs will grow 14.8% between 2016 and 2026, with 7% growth in nursing homes and residential care facilities and 48.6% growth in home health services. Read more...
Staffing and Services in Residential Care Facilities
Residential care communities (RCCs), which are also known as assisted living facilities and residential care facilities, provide long-term services and supports in a residential setting. They provide care to both older and younger adults who need assistance due to disability or cognitive impairment. In 2016, more than 800,000 people lived in nearly 29,000 RCCs in the United States, and 41.9% of them were diagnosed with dementia. Read more...
Nursing Home Staffing Instability During and After the Acute Phase of the COVID-19 Pandemic
Nursing homes are essential in providing care to millions of Americans, with staffing being a crucial factor in providing high quality care. Adequate staffing levels, typically measured as hours per resident day (HPRD) and often measured separately for registered nurses (RNs) and for certified nursing assistants (CNAs), are vital for nursing home quality. Prior studies have shown that staffing instability is associated with poor health outcomes and adds to poor outcomes above and beyond low average staffing and turnover. The importance of staffing is widely recognized and is increasingly becoming a policy focus. Read more...
Personal Care and Home Care Workforce
Impact of COVID-19 on Occupational Injury Among Long-term Care Workers in California: Analysis of Workers’ Compensation Data, 2019 and 2020
The COVID-19 pandemic dramatically increased the need for health care services, and health care workers working on the frontlines are among the most affected occupational groups. Particularly, long-term care facilities — which are the industry with the highest occupational injury and illness rate in the U.S. — have been shown to be more vulnerable to COVID infections. According to the Centers for Disease Control and Prevention (CDC) surveillance data, as of July 4, 2021, in nursing homes in the US, there were 658,169 COVID-19 cases and 133,414 deaths among residents and 588,199 COVID-19 cases and 1,967 deaths among staff. Read more...
Changes in Caregiving During the COVID-19 Pandemic
The aging of the U.S. population will lead to greater demand for assistance with activities of daily living. Much of this support is provided by family members, but changing family sizes and locations have raised concern that those needing support will be increasingly reliant on non-family assistance, including paid caregivers. During the COVID-19 pandemic, the dynamics of family support for people living with disabilities were disrupted due to shelter-in-place orders. Read more...
Health and Health Care Experiences of Direct Care Workers
Direct care workers — who include 4.6 million personal care aides, home health aides, and nursing assistants — support the health and wellbeing of older adults and people with disabilities across long-term care settings. However, as primarily low-income women of color and immigrants, these workers are likely to experience considerable health disparities themselves. As one example, less than half of all direct care workers (46%) have employer-sponsored health insurance, and 15% have no coverage. Read more...
Training Requirements for Personal Care Aides Across the 50 States
This project explored differences in training requirements for Personal Care Aides, who provide assistance to older adults and people with disabilities in their homes and in long-term care facilities. Although there are nearly one million people working in this field, there is little consistency in the training requirements across the 50 states. Our study provided valuable information about regulations, as well as an assessment of the rationale underlying specific training requirements. Read more…
Remote Monitoring Technology in Long-Term Care
Remote monitoring technologies are increasingly being deployed to enable health professionals to monitor patients more closely and intervene more quickly when patients’ health deteriorates. Remote monitoring and structured telephone support have been found to improve health outcomes for chronic obstructive pulmonary disease, congestive heart failure, hypertension, and hyperlipidemia. The most common model is for registered nurses (RNs) or other health professionals to review reported data and contact patients if it appears that the patient’s treatment plan needs to be adjusted. Read more...
Family Member Caregivers for Dual-Eligible Medicare/Medicaid Enrollees
This investigation provided a natural experiment to examine these questions. We examined post-discharge utilization of long-term supports and services (LTSS) among dual-eligible Californians who were discharged from an acute inpatient hospital stay from 2006-2008. Read more...
Licensed Home Care Agencies and Nursing Scope of Practice: Impacts on Persons Needing Assistance in Community Living
Unlicensed assistive personnel who help people in their homes might be employed by a licensed home care agency or can be employed directly by the person who requires assistance. State nurse practice acts and medication aide laws determine who can perform common tasks such as managing catheters, tube feeding, and medication management. Variations in state laws and regulations mean that aides working through agencies may have a more limited scope of practice than if they were hired independently. This could mean that some community-dwelling older adults and people with disabilities might not be able to get the help they need or be forced to enter institutions solely to have access to licensed personnel who can provide the required help. Read more...
Impact of Electronic Visit Verification (EVV) on Medicaid Personal Care Services Workers
The 21st Century CURES Act, enacted by Congress in 2016, requires that all states implement Electronic Visit Verification (EVV) for Medicaid-funded Personal Care Services (PCS) on January 1, 2019 and for Home Health Care Services (HHCS) by January 1, 2023. EVV electronically verifies that a caregiver provides services for a client. According to the Centers for Medicare and Medicaid Services (CMS), EVV will improve program efficiencies by validating service delivery and reducing waste, fraud, and inefficiency. Read more...
Understanding Personal Assistance Services Experiences in Rural States
A recent unpublished nationwide analysis of Census data indicates that rural areas have lower ratios of personal assistance services (PAS) workers to people with disabilities than urban areas. In a collaboration between UCSF and University of Montana, we will explore the PAS workforce in rural communities, using a mixed methods process focusing on 3-4 states with large rural populations. Read more...
Redeployment of Displaced Workers to Direct Care
The direct care workforce, which includes nursing assistants, home health aides, and personal care aides, provides critical daily support to older adults and people with disabilities across long-term care settings. Currently numbering nearly 4.5 million workers, this workforce is expected to add 1.3 million new jobs from 2018 to 2028, which is more new jobs than any other single occupation in the country. Read more...
Effect of Self-Directed Programs on Direct Care Worker Wages
Some states offer self-directed models in their LTSS programs, in which consumers control how available funds are used to purchase the support they need to maximize health and function in the community, including direct hiring of direct care workers (DCWs) who assist them in the home and community. The purpose of this project, which would be conducted in collaboration with RTI International, is to examine the effect of these models on direct care worker wages, specifically the wages of personal care assistants (PCAs). Read more…
The Tribal Home Care Workforce Providing Culturally Informed Care
The COVID-19 pandemic revealed significant problems in occupational and consumer safety in systems that house and provide LTSS. Long-standing problems in systems that provide health care services to tribal nations were exacerbated and emphasized. While the COVID-19 pandemic exposed and magnified the deficits American Indian/Alaska Native (AI/AN) populations experience with elder care, this issue is long-standing and persists during non-emergency periods. Read more...
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. Read more...
Licensed Nurse Employment in Long-Term Care: An Update
Nursing is the largest health profession in the United States and nurses play a major role providing care in a wide variety of health care settings. There are more than 3.8 million registered nurses (RNs) licensed in the United States, including more than 234,000 nurse practitioners (NPs), 81% of whom are employed in nursing. The U.S. Bureau of Labor Statistics estimates that demand for RNs will grow 14.8% between 2016 and 2026, with 7% growth in nursing homes and residential care facilities and 48.6% growth in home health services. Read more...
Personal Care Aide Training Requirements: An Update
Personal care aides (PCAs) provide essential daily assistance to older adults and people with disabilities in private homes and community settings across the United States. This workforce is large and growing rapidly to meet escalating demand for home and community-based services (HCBS). Together, PCAs and home health aides (HHAs) comprise the second largest workforce in the country, and the U.S. Bureau of Labor Statistics projects that the U.S. will add 924,000 new HHA and PCA jobs between 2021 and 2031, which is more job growth than in any other occupation. Read more...
Alzheimer’s and Dementia Care
Alzheimer’s Patient Care Manager Practices and Policies
The goal of this project was to systematically review and analyze care manager policies and practices within health plans participating in CMS’s demonstration programs for dual-eligible Medicare/Medicaid beneficiaries in 11 states. Read more...
Dementia Care Specialist Workforce: Scope of Practice, Training, and Demand
Over five million older adults in the U.S. are currently living with Alzheimer’s disease and related dementia (ADRD); the prevalence of ADRD is expected to rise to 16 million by 2050. The costs of health care, long-term care, and hospice care for individuals with ADRD exceeded $236 billion in 2016, and will rise to $1.1 trillion by 2050. The estimated share of these costs covered by Medicare and Medicaid is expected to increase from $160 billion to over $735 billion by 2050. Read more...
Alzheimer's Staffing, Services, and Outcomes in Adult Day Health Centers
Alzheimer’s Disease (AD) and AD-related dementia (ADRD) is a profoundly debilitating disease with risk increasing with age (Alzheimer's Foundation of America, 2016). This disease will quickly burden a growing percentage of Americans and pose a great challenge for the U.S. health care system. Adult Day Health Centers (ADHCs) are a vital community service whose staff provide specialized care to persons with ADRD and respite to caregivers, which allows them to work, meet obligations, and recover from the daily care burden (O'Keefe & Siebenaler, 2006). It is essential that ADHCs and other LTC providers be readily equipped with the appropriate services and staffing structures to properly care for persons with ADRD. Read more...
Building Primary Care Capacity in Dementia Care Using Project ECHO
More than six million people live with Alzheimer’s disease and related dementias (ADRD) in the United States, a number that is rapidly growing. Primary care providers are gatekeepers to patients with suspected ADRD, yet as many as 66% of patients in primary care are not diagnosed in the early stages of the disease. Primary care physicians report a lack of familiarity with evaluation tools, issues of time, difficulty accessing specialists, reimbursement, difficulty connecting with service agencies, and lack of confidence managing patient and family preferences as major barriers. Read more…
Primary Care Providers’ Perspectives on Process and Outcome Measures Related to Care for People with Alzheimer’s Disease and Related Dementia
More than 7 million people live with Alzheimer’s disease and related dementias (ADRD) in the United States, a number that is rapidly growing. Primary care providers (PCPs) are the first and, in some cases, only point of contact for most patients with suspected and confirmed ADRD, yet numerous studies have found persistent barriers to provision of high-quality primary care for this population. Read more...
Physicians, Nurse Practitioners, Physician Assistants, and Nurses
Impact of COVID-19 on Occupational Injury Among Long-term Care Workers in California: Analysis of Workers’ Compensation Data, 2019 and 2020
The COVID-19 pandemic dramatically increased the need for health care services, and health care workers working on the frontlines are among the most affected occupational groups. Particularly, long-term care facilities — which are the industry with the highest occupational injury and illness rate in the U.S. — have been shown to be more vulnerable to COVID infections. According to the Centers for Disease Control and Prevention (CDC) surveillance data, as of July 4, 2021, in nursing homes in the US, there were 658,169 COVID-19 cases and 133,414 deaths among residents and 588,199 COVID-19 cases and 1,967 deaths among staff. Read more...
Employer Demand for Physician Assistants and Nurse Practitioners in Long-Term Care Settings
By 2030, people aged 65 and older are projected to account for 20% percent of the US population. One solution to meet the demand for health care professionals with expertise in long-term care (LTC) may be to employ more nurse practitioners (NPs) and/or physician assistants (PAs) in LTC settings. To our knowledge, this will be the first study to evaluate the national job market for PAs and NPs in LTC settings. Understanding LTC demand for PAs and NPs will help to guide HRSA’s investment in LTC education versus other high-demand fields. The study will be conducted in partnership with Duke University. Read more...
The Roles and Value of Geriatricians in Health Care Teams
The American Geriatrics Society (AGS) estimates that a total of 30,000 geriatricians will be needed to meet care needs by 2020, and there is currently a shortfall of approximately 13,000 geriatricians. The AGS projects that the shortfall will worsen without greater numbers of graduates of geriatrics training programs. However, some healthcare leaders believe that the needs of the aging population can be met by other physicians – including primary care providers – in addition to professionals such as occupational therapists and nurse practitioners. Read more...
The Licensed Practical Nurse Workforce in Long-Term Care
This study examined changes in LPN supply, educational attainment, demographics, geographic distribution, and employment settings over the past decade. Characteristics of LPNs employed in long-term care settings were compared with characteristics of LPNs working in other health care settings. Read more...
Staff Turnover in Home Health
Over the past decade, payment for home health care services has more than doubled, and its importance has increased with the rise of care coordination and shared savings models. Home health care is also a key component of strategies to reduce institutional long-term care. Home health agencies report high turnover rates – over 21% on average – that challenge their ability to deliver high quality services. Read more...
Registered Nurse Wage Disparities in Long-Term Care
Nursing is the largest health profession in the United States. The nurse workforce includes over 3.8 million registered nurses (RNs), 81% of whom are employed in nursing, as well as more than 234,000 Nurse Practitioners (NPs) in 2017. The U.S. Bureau of Labor Statistics estimates that demand for RNs will grow 14.8% between 2016 and 2026, with 7% growth in nursing homes and residential care facilities and 48.6% growth in home health services. Read more...
Rapid Assessment of Changes in Registered Nurse Employment and Demand during the COVID-19 Pandemic
During the first six months of the COVID-19 pandemic, numerous issues about the nursing workforce were reported, including nursing shortages amidst potential surges and the inability of nursing students to continue their clinical education due to pandemic-related concerns. This could undermine the progress made over the past 20 years toward a balanced nursing labor market and lead to shortages of RNs in the near future. Read more...
Palliative Care Staffing and Services in Long-Term Acute Care Hospitals
Each year, long-term acute care hospitals (LTACHs) care for over 100,000 individuals with complex and serious illness requiring prolonged inpatient care for weeks or months following a short stay hospitalization. Patients cared for in LTACHs are typically older, disproportionately from underserved backgrounds (e.g., Black and dual Medicare-Medicaid enrolled), and have substantial multimorbidity. Read more…
Characteristics of Clinician Providers in Nursing Facilities and the Home
The US adult population is aging while increasing in clinical complexity, which will exacerbate an already strained health care workforce. There are long-standing concerns around ensuring an adequate workforce in nursing facilities. Workforce challenges associated with nursing facilities are multi-pronged – both the supply and training of the workforce may be inadequate. Read more…
Building Primary Care Capacity in Dementia Care Using Project ECHO
More than six million people live with Alzheimer’s disease and related dementias (ADRD) in the United States, a number that is rapidly growing. Primary care providers are gatekeepers to patients with suspected ADRD, yet as many as 66% of patients in primary care are not diagnosed in the early stages of the disease. Primary care physicians report a lack of familiarity with evaluation tools, issues of time, difficulty accessing specialists, reimbursement, difficulty connecting with service agencies, and lack of confidence managing patient and family preferences as major barriers. Read more…
The Composition of Health Providers Prescribing Behavioral Health Medications to Medicare Beneficiaries with Behavioral Health Needs
The Medicare program is anticipating an increase from 54 million beneficiaries today to over 80 million beneficiaries by 2030, many of whom will have longer life expectancies, chronic conditions, mental health problems, and substance use disorders. These population changes will challenge a primary care workforce already in need of more gero-psychiatrists. Read more...
Emerging Care Delivery Models, Interprofessional Teams, and New Occupations
Care Management and Care Coordination in Long-Term Care
Care management and care coordination is a growing field in long-term care, particularly at the interface of long-term care, acute care, and home care. The questions of how care managers are being used, how they are educated for their work, and how they interact with other members of the health care team are largely unanswered. Read more...
Mobile Integrated Healthcare and Community Paramedicine
According to a survey conducted by the National Association of Emergency Medical Technicians (NAEMT) in 2014, more than 100 emergency medical services (EMS) agencies in 33 states and the District of Columbia have implemented mobile integrated healthcare and community paramedicine (MIH-CP) initiatives. MIH-CP is a new model of care in which emergency medical technicians and paramedics (EMT-Ps) are trained to deliver a broader range of services than simply emergency response and transportation to emergency departments.. Read more...
Workforce Impact of Emerging Technologies in Long Term Care
By 2030, people 65 and older are projected to account for 20% of the U.S. population (U.S. Census Bureau, 2012); by 2017 over 70% of disposable income in the U.S. will be in the hands of those over 60 years old (World Economic Forum, 2015). Rapidly emerging technological advances hold great potential for people to navigate the social, cognitive and physical changes associated with aging (President’s Council of Advisors on Science and Technology, 2016). Read more...
The Workforce for Adult Protective Services
Adult protective service programs protect elders and adults with disabilities from abuse, neglect, exploitation, and self-neglect. Adult protective services programs are often provided by county government agencies but also can be housed within nonprofits and other levels of government. Adult protective services workers are charged with the role of protecting vulnerable adults who may be experiencing abuse. Read more...
Community Paramedics: A Valuable Resource for Addressing the COVID-19 Pandemic
The COVID-19 pandemic is challenging communities to adopt new models of care to conserve scarce inpatient resources. Some communities across the United States have responded by leveraging community paramedics, an existing workforce that is well-positioned to provide services in community-based settings. Read more...
Building Primary Care Capacity in Dementia Care Using Project ECHO
More than six million people live with Alzheimer’s disease and related dementias (ADRD) in the United States, a number that is rapidly growing. Primary care providers are gatekeepers to patients with suspected ADRD, yet as many as 66% of patients in primary care are not diagnosed in the early stages of the disease. Primary care physicians report a lack of familiarity with evaluation tools, issues of time, difficulty accessing specialists, reimbursement, difficulty connecting with service agencies, and lack of confidence managing patient and family preferences as major barriers. Read more…
Nursing Homes
Electronic Health Records in Nursing Homes
A growing share of nursing homes and skilled nursing facilities use electronic health records (EHRs), but its adoption is still not widespread. Prior research has reported that the need for training and the culture change associated with EHRs are important barriers to implementation. Greater satisfaction with EHRs in nursing homes is associated with good training resources and effective implementation strategies. Read more...
Medical Staff Organization, and Relationships Between Directors of Nursing and Medical Staff, and Nursing Home Quality
Nursing homes are critical components of the LTC continuum. Acute care systems recognize the need for high quality and easily accessible post-acute LTC (rehabilitation). While nursing home quality is dependent on a number of workforce factors, physicians are clearly an important part of the team. Primary care physicians often graduate and enter practice without any meaningful exposure to post-acute LTC (PA-LTC) or to geriatric medicine in general. Read more...
Opioid Prescribing Patterns in Skilled Nursing Facilities
The Medicare population has one of the highest and fastest-growing rates of diagnosed opioid use disorder. With approximately 20% of hospitalized Medicare beneficiaries being discharged to skilled nursing facilities (SNFs), licensed health professionals working in SNFs are providing pain management to beneficiaries who are just starting on opioids as part of post-surgical pain management and to beneficiaries with chronic pain who may have developed dependence on opioids. Read more...
Trends in Contract Nursing Assistant Staffing and Quality of Care
Certified nursing assistants (CNAs) play a critical role in ensuring quality care for nursing home residents. They provide twice as many hours of hands-on care per resident per day than licensed practical nurses and registered nurses combined, and the amount of care provided by CNAs is positively associated with improved quality outcomes for residents. During the COVID-19 pandemic, higher CNA staffing levels have been associated with a reduced likelihood of COVID-19 outbreaks and deaths among residents. Read more…
Characteristics of Clinician Providers in Nursing Facilities and the Home
The US adult population is aging while increasing in clinical complexity, which will exacerbate an already strained health care workforce. There are long-standing concerns around ensuring an adequate workforce in nursing facilities. Workforce challenges associated with nursing facilities are multi-pronged – both the supply and training of the workforce may be inadequate. Read more…
In the trenches: Front-line workers’ burnout experiences in long-term care settings in the COVID-19 pandemic
Burnout is a well-known and longtime issue originating from various reasons leading to negative consequences such as depression and anxiety among the workers and lower quality of care in both acute and long-term care. Read more...
Licensed Nurse Employment in Long-Term Care: An Update
Nursing is the largest health profession in the United States and nurses play a major role providing care in a wide variety of health care settings. There are more than 3.8 million registered nurses (RNs) licensed in the United States, including more than 234,000 nurse practitioners (NPs), 81% of whom are employed in nursing. The U.S. Bureau of Labor Statistics estimates that demand for RNs will grow 14.8% between 2016 and 2026, with 7% growth in nursing homes and residential care facilities and 48.6% growth in home health services. Read more...
Staffing and Services in Residential Care Facilities
Residential care communities (RCCs), which are also known as assisted living facilities and residential care facilities, provide long-term services and supports in a residential setting. They provide care to both older and younger adults who need assistance due to disability or cognitive impairment. In 2016, more than 800,000 people lived in nearly 29,000 RCCs in the United States, and 41.9% of them were diagnosed with dementia. Read more...
Nursing Home Staffing Instability During and After the Acute Phase of the COVID-19 Pandemic
Nursing homes are essential in providing care to millions of Americans, with staffing being a crucial factor in providing high quality care. Adequate staffing levels, typically measured as hours per resident day (HPRD) and often measured separately for registered nurses (RNs) and for certified nursing assistants (CNAs), are vital for nursing home quality. Prior studies have shown that staffing instability is associated with poor health outcomes and adds to poor outcomes above and beyond low average staffing and turnover. The importance of staffing is widely recognized and is increasingly becoming a policy focus. Read more...
Behavioral Health
Peer Providers in Behavioral Health and Substance Abuse Treatment
For this study, we conducted case studies in 3 states that exemplify best practices in peer provider training, employment, and reimbursement for both Mental Health (MH) and Substance Abuse (SA) peer providers. Read more...
The Composition of Health Providers Prescribing Behavioral Health Medications to Medicare Beneficiaries with Behavioral Health Needs
The Medicare program is anticipating an increase from 54 million beneficiaries today to over 80 million beneficiaries by 2030, many of whom will have longer life expectancies, chronic conditions, mental health problems, and substance use disorders. These population changes will challenge a primary care workforce already in need of more gero-psychiatrists. Read more...
Peers in the Behavioral Health Workforce: Costs and Contributions
Prior studies have analyzed the effectiveness of peer support workers (or consumer-providers), those who have lived experience with mental illness and/or substance use disorder, in the provision of behavioral health services. A 2013 Cochrane Review of 11 randomized controlled trials concluded that service use outcomes for clients were no better or worse when mental health teams included consumer-providers. Read more...
Palliative Care
Palliative Care Workforce: Team Composition Across Settings
This project produced a detailed analysis of the data available on hospital-based programs, and also produced qualitative findings that could be used to guide a national survey of community-based programs. This study was conducted in collaboration with the Center to Advance Palliative Care. Read more...
Palliative Care Staffing and Services in Long-Term Acute Care Hospitals
Each year, long-term acute care hospitals (LTACHs) care for over 100,000 individuals with complex and serious illness requiring prolonged inpatient care for weeks or months following a short stay hospitalization. Patients cared for in LTACHs are typically older, disproportionately from underserved backgrounds (e.g., Black and dual Medicare-Medicaid enrolled), and have substantial multimorbidity. Read more…