This report describes the gaps and limitation in data about direct care workers providing LTSS, hampering ability to identify trends and make needed workforce projections.   

Why GAO Did This Study

The U.S. Government Accountability Office (GAO) was asked to provide information on direct care workers who deliver long-term services and supports (LTSS). Difficulties recruiting and retaining direct care workers and the anticipated growth in the elderly population have fueled concerns about the capacity of the paid direct care workforce to meet the demand for LTSS. However, policymakers lack data to help assess the size of the problem.

  • This report examines
    • (1) available federal and state data on the paid direct care workforce; and
    • (2) actions Health Resources and Services Administration (HRSA) has taken to develop information project supply and demand, and overcome data limitations related to the direct care workforce.
  • GAO analyzed the most recent data available from the Census Bureau and Bureau of Labor Statistics on paid direct care workers’ demographics, compensation, and benefits; reviewed efforts to collect data on direct care workers in 4 states,  Arkansas, Maine, Minnesota, and Oregon; reviewed HRSA documents; interviewed HRSA officials about efforts to improve data. 

What GAO Found

  • Federal data sources provide a broad picture of direct care workers—nursing assistants and home health, psychiatric, and personal care aides—who provide LTSS, but limitations and gaps affect the data’s usefulness for workforce planning.
  • Federal data show direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 % of the nation’s health workforce.
  • Wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015.
    • It is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. Some states studies indicated a majority of independent providers worked for a family member or someone they knew. 
  • HRSA, responsible for monitoring the supply of and demand for health professionals, has developed some information on direct care workers, but has not produced projections of this workforce or developed methods to address data limitations. 
    • HRSA’s actions include sponsoring research and issuing a 2013 report summarizing federal data on different occupations, including direct care workers. Unless HRSA takes steps to overcome data limitations to make projections of supply and demand for direct care workers, policymakers will continue to be hampered in their ability to identify workforce trends and develop appropriate strategies to help ensure a sufficient number of qualified direct care workers. 

GAO Recommendation

  • GAO recommends that HRSA take steps to produce projections of direct care workforce supply and demand and develop methods to address data limitations to do so.
  • HHS concurred with GAO’s recommendation, stating that developing projections for the direct care workforce is timely and important.