Source:UCSF Health Workforce Research Center on Long-term Care , UCSF Health Workforce Research Center on Long-term Care , San Francisco (2018)
Keywords:diversity, educational attainment, LTC workforce, occupation
<p>Objective/Issue: There will be significant growth in the need for long-term care (LTC) services over the next few decades, and the users of those services will become increasingly racially/ethnically diverse. Consumers of healthcare services report a preference for providers who share their own race/ethnicity and cultural background for varying reasons. These findings raise questions about how racial and ethnic diversity is reflected in the current LTC workforce, and how the demographic make-up of the workforce will be matched to consumer needs in the future.
Data/Setting: Using data from the 2015 American Community Survey Public Use Microdata Sample (1-year file) the report describes general employment and demographic characteristics of the LTC workforce in the United States.
Design/Methods: Data describing characteristics of the current LTC workforce were sourced from the 2015 American Community Survey (ACS), 1-year Public Use Microdata Sample (PUMS). The PUMS data are untabulated records describing either people or housing units, representing individual survey responses. The report analyzes survey weights to produce estimates generalizable to the U.S. civilian population. Data describing graduates of LTC-related education programs were sourced from the 2015 Integrated Postsecondary Education Data System (IPEDS) and a customized file prepared by the American Association of Colleges of Nursing (AACN).
Results/Findings: Total Employment in Long-term Care
• Estimates derived from ACS data indicate that 3.3 million Americans were employed in a healthcare-related occupation in LTC in 2015.
• The single largest occupational group was nursing/psychiatric/home health aide, which accounted for 38% of all healthcare-related employment in LTC.
• The 4 occupational groups of nursing/psychiatric/home health aides, personal care aides, registered nurses, and licensed vocational nurses accounted for 84% of all healthcare-related employment in LTC.
Composition of the LTC Workforce by Employment Setting
• SNFs and home health agencies employed the majority of workers. 43.6% of Americans working in LTC were employed by SNFs and 35% were employed by home health agencies.
• The occupational composition of LTC workers varied across the four industry settings.
o Personal care aides accounted for the overwhelming majority of workers in private households (85.8%), and were also the largest occupation employed by residential care facilities (39.0%).
o Nursing/psychiatric/home health aides accounted for the largest shares of persons working in SNFs (43.9%) and home health agencies (42.8%).
o Registered nurses were predominantly employed in either a SNF (18% of persons working in SNFs) or a home health care setting (12.3% of persons working in home health care).
Conclusions/Discussion: While there will be some opportunities for increasingly racially/ethnically diverse clients to receive care from racially/ethnically concordant LTC workers, all LTC workers will need the skills to care effectively for persons from other racial/ethnic groups and to work effectively with co-workers from different racial/ethnic groups. The finding of an inverse relationship between racial/ethnic diversity and educational attainment suggests a need to provide opportunities for aides to pursue further education so that they can enter other, better paying LTC occupations, such as LVN and RN positions. Diversifying the RN workforce in LTC is especially important because RNs often work in leadership positions. Employers should provide financial assistance to aides who wish to pursue nursing education and offer them part-time employment while completing their education in exchange for an agreement to work for the LTC employer following graduation.