Academic journal article Generations

A Critical Look at the Looming Long-Term-Care Workforce Crisis

Academic journal article Generations

A Critical Look at the Looming Long-Term-Care Workforce Crisis

Article excerpt

To alleviate coming workforce shortages, employers, educational institutions, federal and state policy makers, and consumer advocates must recognize long-term care as a vital component of the larger healthcare market.

Over the past decade, numerous studies have documented a growing long-term-care workforce crisis. These studies have usually focused on the shortages of direct-care workers who provide the great bulk of formal care (Stone and Harahan, 2010; Institute of Medicine, 2008; Health Resources and Services Administration, 2004; Office of the Assistant Secretary for Planning and Evaluation, 2003). Much less attention has been paid to the role and status of licensed professionals who supervise direct-care staff and provide health and ancillary services in long-term-care settings. Shortages of competent and dedicated long-term-care professionals- particularly among licensed nurses-continue to be ubiquitous across all long-term-care sectors. In comparison, the recession has significantly eased the shortage of hospital-based nurses. Between 2007 and 2008, employment of registered nurses (RNs) in hospitals increased by 18 percent-the largest increase in thirty years. During this same period, 50,000 nursing positions were lost in non-hospital settings, including nursing homes and homecare agencies. Hospitals offer a competitive advantage over long-term-care employers because of higher wages, better benefit packages, and more attractive work schedules (Buerhaus, Auerbach, and Staiger, 2009).

The remainder of this article summarizes the roles and responsibilities of licensed long-termcare professionals, discusses the capacity and commitment of these professionals to meet the increasingly diverse long-term-care needs of a growing older adult population, and suggests reforms to attract and retain high-quality long-term-care professionals.

The Roles of Licensed Long-Term-Care Professionals

Licensed professionals employed by nursing homes, assisted living facilities and home health and personal care agencies include administrators, physicians, nurses, social workers, mental health professionals, and consulting pharmacists.


Nursing homes reimbursed by Medicare or Medicaid are required to have a physician medical director to oversee the medical care of residents and participate in the design of residents' care plans. The federal government does not require assisted living facilities and home health agencies to have a medical director, although many do. According to recent research, medical directors, usually primary care physicians, devote about 44 percent of their practice to nursing homes. A significant minority have some special training in geriatrics (Caprio, Karuza, and Katz, 2009). The involvement of other physicians in caring for long-term-care patients seems to fade away once an individual is admitted to a long-term-care institution. A 2006 survey conducted by Katz and Karuza found that only one in five self-identified primary care physicians reported any involvement in nursing homes. Those who were involved averaged about two hours per week (Katz and Karuza, 2006). An important factor in physicians' reluctance to work in nursing homes is their fear of medical malpractice and liability risk (Kapp, 2008).

Nursing home and home health administrators

Nursing home and home health administrators are responsible for all aspects of their respective organizations, including supervision and management of staff, and compliance with federal and state regulations. The federal government requires states to license nursing home administrators. However, there are no national standards, and state licensing requirements vary widely. Several studies (Singh and Schwab, 2000; Castle, 2001; Castle, 2006) show high rates of administrator turnover in nursing homes. The credentialing of assisted living facility, home health agency, and other home- and community-based service agency administrators is left to states. …

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