What We Don’t Know About Direct Care Workers Could Hurt Us

Robyn's Read | September 21, 2016

We know some important things about the direct care workforce that provides long-term services and supports to millions of older Americans. But it’s what we don’t know that could hurt us, according to a new report from the Government Accountability Office.

We know some important things about the direct care workforce that provides long-term services and supports (LTSS) to millions of older Americans.

But it’s what we don’t know that could hurt us, according to a new report from the U.S. Government Accountability Office.

What We Know

We know, for example, that as our older population grows larger, and as our lifespan lengthens, more elders will need the kind of hands-on care that the direct care workforce delivers in a wide variety of settings around the nation.

We’ve done a good job of documenting the challenges associated with recruiting and retaining well-trained workers to provide these services and supports to current elders.

So we’re fairly certain that building a strong workforce will become even more challenging in the coming decades as the demand for services increases just when our pool of potential workers begins to shrink.

What We Don’t Know

What we know about our coming workforce crisis is a cause for concern.

But, what we don’t know about direct care workers is downright scary.

Believe it or not, we don’t actually know how many direct care workers are currently providing services and supports through nursing homes, assisted living communities, or certified home health agencies.

We know even less about workers that the GAO calls “independent providers.” These workers provide LTSS through private arrangements with an older adult or his or her family. We don’t know who these workers are, where they do their work, or how much training or compensation they receive. That’s a lot not to know.

We don’t know where in the country our supply of direct care workers is most plentiful. Conversely, we don’t know which regions are currently experiencing worker shortages -- or will experience those shortages in the future.

We have a general idea of what direct care workers earn -- between $10 and $13 an hour, according to GAO. But we have no idea if those figures apply to all direct care workers, including independent providers, or what job-related benefits these workers receive, if any.

We have no federal data on job openings and turnover, which is critical to determining how stable, or unstable, this workforce is today and will be in the future.

And, finally, we don’t have a clear idea of how many additional workers we’ll need over the next few decades in any of these settings.

GAO Sounds the Alarm

This lack of data drives researchers like me crazy. I was glad to see that it’s driving GAO crazy too.

In its 47-page report to Congress, the bipartisan Congressional “watchdog” agency says it’s unlikely that the paid direct care workforce will have the capacity to meet the demand for LTSS as the older population grows.

That’s bad enough. But the GAO’s sobering conclusion is that policy makers simply don’t have enough information to assess the extent of the workforce crisis.

That lack of knowledge will hurt us if it’s not corrected.

After all, how can we develop a quality LTSS system without a clear picture of what the workforce looks like?

How can we know what we need in terms of human capital when we don’t even know what we have?

How can we develop additional resources to strengthen the workforce if we don’t even know where to target those resources?

Getting Better Workforce Data

Getting our hands on better data won’t be easy, because the LTSS sector is very diverse and not all settings collect good data, or organize that data in the same way.

We might have the best chance of success if we work with Medicaid agencies at the state level to collect targeted workforce data. After all, these agencies invest in LTSS programs that employ many direct care workers. They have better access to these workers than the federal government does. And they have a lot at stake when it comes to strengthening the future LTSS workforce.

But the federal government also has an important role to play.

The Health Resources and Services Administration (HRSA), which is responsible for monitoring the supply of and demand for health professionals, might consider working with the Centers for Medicare and Medicaid Services and the Department of Labor to fund pilot programs that test different methodologies for collecting data in select states with different characteristics.

These agencies might then collaborate on creating incentives that would encourage states to adopt proven methods for collecting and reporting data about the LTSS workforce.

It’s Not About the Research

I’m thrilled to see government agencies like GAO focusing on the need for better data.

But let’s be realistic.

We’ll never have a perfect method for collecting the data we need about our far-flung direct care workforce. And we’ll never capture data about every worker in every setting.

But that doesn’t mean we shouldn’t try to do better.

We’re not doing this for the sake of researchers like me. After all, this is not an academic exercise.

Let’s do it, instead, for the direct care workers who are largely responsible for the quality of our LTSS system.

And let’s do it for the millions of older Americans and their families who depend on that system today and will depend on it even more in the decades ahead.