The Patient Protection and Affordable Care Act (ACA) promises to transform the way our nation delivers and pays for long-term services and supports, but the new law can't be successfully implemented without the creation of a “substantially different health and long-term care workforce than exists today,” according to Dr. Robyn Stone, executive director of the LeadingAge Center for Applied Research, in a new Journal of Aging and Social Policy article.
ACA: Workforce Challenges and Opportunities
According to Stone, the ACA established a number of demonstration programs and payment reforms to encourage better service coordination and integration for older adults with multiple chronic illnesses and disabilities. At the same time, the new health care reform law also called for an expansion of home and community-based services as a way to increase choice and lower care costs for older people in need of long-term services and supports. Both approaches to reform have important implications for the eldercare workforce, she says.
For example, says Stone, the new models of integrated service delivery outlined in the ACA require that care and management staff understand how to coordinate care both at the organizational and consumer level, work in interdisciplinary teams, document and share clinical information, and place the elderly consumer at the center of care decisions.
In addition, the ACA’s emphasis on expanding home and community-based care requires a substantial increase in the number of direct-care workers and management staff as well as a concerted effort to strengthen the competencies of this workforce in such areas as medication management, dementia care and palliative care, she says.
Thanks to advocacy groups like the Eldercare Workforce Alliance (EWA), of which LeadingAge is a member, the ACA acknowledges the additional demands that its provisions will place on the workforce, says Stone. A number of ACA workforce provisions promise to increase educational opportunities in the areas of geriatrics and gerontology and provide incentives for individuals to enter and remain in the field. Other workforce-related provisions support the development of relevant curricula that provide workers with the competencies they will need to care for a growing older population with increasingly complex needs.
As promising as these workforce provisions appear, however, their mere presence in the ACA legislation won't guarantee the availability of a knowledgeable, skilled and competent health and long-term care workforce, says Stone. For this reason, the EWA continues to advocate for the implementation and funding of these provisions and the inclusion of workforce elements in all future payment and delivery reforms, she says.
“System reform doesn’t happen magically,” says Stone. “Health reform will only become meaningful reform if we make sure that workforce issues are really addressed at every step along the way. You can’t bring about these kinds of reforms simply by changing policy. You have to recognize that because the system is so labor intensive, reforming that system has to involve paying close attention to the human capital.”
Calling Attention to Workforce Issues
Stone first began calling attention to ACA-related workforce issues when she served as guest editor of the Winter 2010-2011 edition of Generations, the journal of the American Society on Aging. In an introduction to that issue, she suggests that both the ACA, and the 2008 Institute of Medicine report Retooling for an Aging America, have helped to raise workforce issues “to a priority level in both policy and practice areas.”
Those same themes were reflected in Stone’s June 2011 presentation at the prestigious Annual Research Meeting of AcademyHealth, a national organization promoting health services research to improve health care. The organization uses a peer-reviewed process to select the researchers who will present findings from their published work at the annual research meeting. In addition to participating in a session called “The Affordable Care Act and Long-Term Care: Meaningful Reform or Just Tinkering Around the Edges?” Stone chaired a separate AcademyHealth session on “Quality of Long-Term Care.”