Trends in Long-Term Care Service Use and Workforce Demand Predictions

The changing demographic characteristics of the U.S. population indicate that older adults of the future will be more ethnically and culturally diverse and will include a greater share of the oldest old. These changes in the aging population will affect projected demand for LTC services, including the preferred settings in which care is delivered, and the requisite workforce to meet the demand. This study used national surveys to examine the use of LTC services by race and ethnicity, linked this demand to the need for LTC workers, assessed the potential impacts of changing demographics and health status on future demand, and considered the influence of LTC components of the Affordable Care Act on future workforce demand. We extended existing analyses and 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.


Key Questions

  1. What is the relationship between demographic characteristics and use of each type of LTC service?
  2. What is the staffing mix currently being used to deliver each type of service?
  3. What is the projected future use of LTC, based on demographic forecasts, and will current utilization patterns persist?
  4. How will changes fomented by the Affordable Care Act affect these forecasts? 

Journal Article

A study by UC San Francisco researchers led by 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 and the UCSF Health Workforce Research Center predicts that 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. The study has been published in the June 2015 issue of Health Affairs, Future Demand For Long-Term Care Workers Will Be Influenced By Demographic And Utilization Changes.

The study authors, Joanne Spetz, Laura Trupin, Timothy Bates, and Janet M. Coffman posit 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. “Filling these jobs will be a big challenge under any scenario.”

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.

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.” - See more at: 

Contact the project lead, Joanne Spetz.