by changes in demographics and utilization patterns? Joanne Spetz, - - PowerPoint PPT Presentation

How will long-term care workforce demand be impacted by changes in demographics and utilization patterns?

Joanne Spetz, PhD Laura Trupin, MPH Timothy Bates, MPP Janet Coffman, PhD University of California, San Francisco

This study was supported by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) under the Cooperative Agreement for a Regional Center for Health Workforce Studies (Grant No. U81HP26494). The information or content and conclusions of this article are those of the authors and should not be construed as the official position or policy

• f, nor should any endorsements be inferred by, HRSA, HHS, or the

US government.

The looming long-term care crisis

• By 2030: More than 70 million people 65 years and older
• 20% of the population
• By 2050: Number needing long-term care will more than double
• 8 million in 2000 to 19 million in 2050
• Who will care for those with long-term care (LTC) needs?
• IOM projects 3.5 million additional workers by 2030
• This study examines how changing demographics and service use

might affect future LTC worker demand

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Long-term care settings and workforce

• Settings for LTC
• 25% institutions

‒ Nursing homes ‒ Assisted living

• 75% home and community based services (HCBS)
• Workers
• Within institutions: mostly RNs, LPNs, CNAs
• HCBS: mostly unlicensed direct-care workers

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Changing patterns of LTC use?

• General trend toward more HCBS use
• Demographics
• Growing Hispanic & Asian populations

‒ Traditionally use fewer LTC services

• Growing Black population

‒ Traditionally uses more LTC services

• New programs supporting HCBS
• ACA made $4.3 billion available through multiple programs

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Methods

1. Measure use of 4 types of LTC services by age/ethnic/gender 2. Extrapolate future use based on population projections 3. Measure employment by occupation in each LTC service sector 4. Extrapolate future worker demand by occupation using data from steps 2 & 3 (Yes, this is a giant spreadsheet exercise!)

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Data sources: A hunting expedition

• National Health and Aging Trends Survey (NHATS) 2011
• Nursing home
• Residential care (assisted living and continuing care

communities)

• Medical Expenditures Panel Survey (MEPS) 2009-2011
• Home health services (ratio of users/population)
• National Study of Long-Term Care Providers (NSLTCP) 2013
• Adult day care center clients/population
• Census Bureau: Population estimates 2010 & projections

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Employment data

• National Study of Long-Term Care Providers
• Nursing FTEs for RNs, LPNs, and nursing assistants
• Data reported for each type of setting
• BLS National Employment Matrix
• Matched to settings using NAICS codes
• Combined home health aides & personal care aides

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Jobs/FTEs in long-term care

181,527 236,109 784,006 1,345,100 328,400 250,400 173,600 131,100 128,000 123,800 400,000 800,000 1,200,000 1,600,000 RN (FTE) LPN (FTE) Nursing asst. (FTE) HHA/PCA Food prep/serving Office/admin support Building/grounds maint. Comm & soc serv workers Managemnet Counselors & social workers

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Use of services by women 75-84 years

200 400 600 800 1000 1200 1400 1600 1800 2000 Nursing homes Residential care Home health Adult day care White Black Hispanic Other

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Women use nursing homes, residential care, and home health at higher rates than men.

Users of LTC service per FTE worker

20 40 60 80 100 120 140 160 180 Nursing homes Residential care Home health Adult day care RN LPN Nursing Asst.

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Other patterns of employment

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• Home health & personal care aides
• More in residential care, home health, adult day care
• Food prep & serving, Building & grounds maintenance
• More in nursing homes & residential care
• Office & administrative support, Community & social services

workers, Counselors & social workers, Management

• More in adult day services

Projected job/FTE growth: 2010-2030

Occupation New jobs Growth RN (FTE) 132,869 73% LPN (FTE) 166,242 70% Nursing assistants (FTE) 534,548 68% HHA/PCA 1,188,897 88% Food prep & serving 219,457 67% Office & admin support 196,416 78% Building & grounds maint. 119,715 69% Comm & soci serv 121,700 93% Management 99,827 78% Counselors & soci work 116,171 94% Total (jobs+FTE) 2,895,842 79%

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Alternate scenarios

1. Demographic scenarios

• A. Hispanics at same rates as Whites
• B. Hispanics at same rates as Blacks
• C. Blacks at same rates as Whites

2. LTC settings

• A. Nursing home use is 10% lower, shifts to home health
• B. Nursing home use is 20% lower, shifts to home health
• C. Nursing home is 10% lower, shifts to residential care

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Demographic scenarios

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Total RN LPN Nursing asst Baseline Hispanic=>White Hispanic=>Black Black=>White

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Demographic scenarios

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% HHA/PCA Food prep/serv Maintenance Baseline Hispanic=>White Hispanic=>Black Black=>White

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Demographic scenarios

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Office/admin Management Comm/soc serv Counselor/soc wrk Baseline Hispanic=>White Hispanic=>Black Black=>White

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Utilization scenarios

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Total RN LPN Nursing asst Baseline 10% NH=>HH 20% NH=>HH 10% NH=> RC

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Utilization scenarios

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% HHA/PCA Food prep/serv Maintenance Baseline 10% NH=>HH 20% NH=>HH 10% NH=> RC

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Utilization scenarios

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Office/admin Management Comm/soc serv Counselor/soc wrk Baseline 10% NH=>HH 20% NH=>HH 10% NH=> RC

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Limitations

• Not a microsimulation model
• Not a dynamic model
• Only considered older population
• Young adults and children are 1/3 of LTC population
• Some services are not measured
• Unlicensed home health agencies
• Could not disaggregate Asians & “other” ethnic groups
• Had to estimate some age-gender-ethnicity cells

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Policy implications

• Demographic change could affect job growth for specific
• ccupations, but overall job growth for LTC doesn’t change much
• Greater use of home health (and less of nursing homes) will have

small effects unless the shift in setting is large

• Expansions of HCBS will be needed – ACA investments are not

enough

• Need to consider:
• Training requirements for PCAs and HHAs
• Strategies to reduce turnover
• Making sure these are not poverty-level jobs

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