Robyn Stone: How to Shift from an “Accidental” to a “Valued” Workforce

by Published On: Oct 02, 2012Updated On: Mar 31, 2015

Many people enter the field of long-term care “accidentally,” writes Dr. Robyn Stone in a new book from the Russell-Sage Foundation that explores Universal Coverage of Long-Term Care in the United States.

Nurses may move to long-term care after becoming burned out in another health care sector. Physicians may become part-time medical directors because it appears to be a convenient and less-then-demanding sideline. Direct care workers may view their long-term care jobs as stepping stones to other occupations.

Stone, who is executive director of the LeadingAge Center for Applied Research, uses her chapter on “The Long-Term Care Workforce: From Accidental to Valued Profession” to suggest that it’s time to change these attitudes.

“We must shift the perception of work in long-term care from an accidental occupation to one which is attractive, rewarding and valued by society,” she writes.

Workforce Challenges

Stone’s chapter echoes widespread concerns that the caregiving workforce will not be prepared to meet the future demand for long-term care from a growing older population. A variety of factors will make it difficult to recruit and retain competent licensed and direct care workers who will manage, supervise and deliver needed services, she says. Those factors include:

  • Negative stereotyping of long-term care environments and workers.
  • Noncompetitive compensation and benefits.
  • Inadequate education and training.
  • A challenging work environment featuring a hierarchical chain-of-command structure and physically taxing jobs that often lead to injury.

Solutions to the Workforce Crisis

Unless we address workforce challenges promptly, warns Stone, the nation will face a number of troubling outcomes. Consumers will have an increasingly difficult time accessing needed care. High retention rates will cause labor costs to rise sharply and will overburden the existing workforce. Inadequate training will eventually compromise quality of care.

Stone suggests three areas for immediate action:

  • Expand the supply of workers. Offer scholarships and loan forgiveness to individuals willing to enter and remain in the long-term care field. Support a variety of training models, including apprenticeship programs. Explore new pools of potential workers, including recipients of Temporary Assistance for Needy Families, high school students and immigrants. 
  • Invest in education and training. Policymakers, educators and employers must work together to assess the adequacy of current educational efforts. These stakeholders must also identify curricula and competencies necessary to strengthen and expand the long-term care workforce. 
  • Make jobs more competitive. Higher wages and access to affordable health insurance are a good place to start. In addition, federal policy makers should offer financial incentives that encourage long-term care employers to reduce turnover, increase staff retention and achieve better quality outcomes through workplace redesign and continuous quality improvement. 

Reason for Hope but More Work Ahead

Stone ends her chapter on a positive note. After 20 years of debate about how to reform long-term care, the development of its workforce is finally beginning to receive the attention it deserves, she writes. 

In a separate interview with the Russell-Sage Foundation, Stone refers to several initiatives that are currently addressing workforce challenges, including provisions in the Affordable Care Act that support the development and dissemination of competency-based training curricula.

These steps are encouraging, says Stone, but they are not enough.

“Much more is needed if we are really committed to a competent, stable workforce that is essential for the delivery of quality care today and in the future,” she says.


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