2003 National Health Policy Conference

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1 2003 National Health Policy Conference January 22-23, 2003 J.W. Marriott Washington, D.C.

2 Critical Workforce Issues in Long Term Care Carol Raphael, President & CEO Visiting Nurse Service of New York 2003 National Health Policy Conference, Washington, D.C., January

3 Demand for Long Term Care Services 2

4 Demand: Demographic Trends Baby boom generation to retire in 2010 There are 32 million people aged 65+ By 2030: 70 million will be over 65, or 1 in 5 people Number of people aged 85 and over will double to 7 million in 2020: This number will double again to 14 million by

5 Demand: Service Trends As population ages: Greater use of LTC services Expansion of home and community-based care and residential settings Need for assistance with A.D.L.s and I.A.D.L.s 40% (8.5 million) of those aged over 70 have at least one A.D.L/ I.A.D.L. May increase to 21 million by 2030 By 2050, over 25 million people will be limited in activities and need assistance 4

6 LTC Workforce Compared with Other Health Care Sectors Role of: Nurses in home and community-based system Paraprofessionals: Provide 70-90% of direct care to the elderly Informal caregivers: Family members comprise 70% of caregivers 42% are adult children and 25% are spouses May precede, accompany or substitute for formal care National economic value: $257 billion annually* 1 in 4 households *Source: National Family Caregivers Association per HCFA, Office of the Actuary, Levit K. et al, Health Affairs 2002;21 5

7 LTC Workforce Compared with Other Health Care Sectors, continued Role of: Patient/customer preferences: Control Security Knowledge Length of Relationships Cultural Diversity Proxy for Quality 6

8 Supply: Who Comprises the LTC Workforce? 7

9 Profile of the LTC 1 Workforce Nurses Paraprofessionals Informal Caregivers 2 1. Number 512, , million 4 2. Average Age % racial/ethnic minority 6 10% 85% - 90% 49% 4. Earnings 7 $42,071 < $10,000 - $14,000 $0 1 Defined as the chronically ill, disabled or elderly population who need some type of social or medical care; 2 Caregivers who provide care to the LTC population as defined in this chart. 3 Assumes that 20% of total licensed RNs (or, 2.558M RNs per MinorityNurse.com) are in LTC; 4 Source: National Family Caregiving Association survey, 2000; 5 Sources: Family Caregiving Alliance, Direct Care Alliance; 6 Sources: MinorityNurse.com, Direct Care Alliance, Navaie-Waliser, M., American Journal of Public Health, 2002; 7 Source: same as footnote 6. 8

10 Macro Factors Affecting Supply Formal Labor Market Health Care Policy Immigration Welfare Policy Informal Women in workforce Family size Mobility 9

11 What Affects Both Formal & Informal Caregivers Key Point: Widening Gap Traditional Supply of Paid & Non-Paid Caregivers is Shrinking 12% 10% 8% By % 6% 4% 2% 0% -2% Women Aged Women Aged % -6% -4% Source: Bureau of Labor,

12 Main Factors in RN Supply Shrinking Pool: Less enrollment in nursing schools Other career opportunities Nursing education focused on acute care Under-representation of minorities Gender issues 11

13 Main Factors in RN Supply, continued 2500 The Aging of the RN Workforce s 50s 40s 30s 20s (proj.) 2010 (proj.) 2020 (proj.) Source: American Hospital Association: Trend Watch, June 2001, Vol. 3, No. 2 *Number of RNs in thousands 12

14 Main Factors in RN Supply, continued Working Conditions: Complex patients with multiple conditions and comorbidities Increased regulatory burden & required documentation Need to keep up with rapid advances in medicine and technology Interaction with family dynamics Role as care manager 13

15 Main Factors in RN Supply, continued Results: High turnover High vacancy rates Increased retirement rate 14

16 Paraprofessional Supply Issues Projected Paraprofessional Shortage by 2010 Demand 907 Supply In thousands Source: Bureau of Labor, 2001 and Paraprofessional Healthcare Institute 15

17 Paraprofessional Supply Issues, continued 2. Working Conditions: Compensation Benefits Difficult to get steady, full-time employment Lack of career mobility Little respect and recognition Demanding job: High rate of injuries Unpleasant tasks 16

18 Paraprofessional Supply Issues, continued Results: High turnover rates: 94% - 100% in SNFs 32% in home health care Unionization efforts 17

19 Family Caregiver Supply Issues 12 Family Caregivers per Person Needing Care % Decrease in Supply Source: Family Caregiving Alliance

20 Family Caregiver Issues Other Issues: Hard to navigate health system High stress levels Burdens: Financial: Change of work status» Missed work» Decreased productivity» Loss of job or career opportunities Emotional: 51% suffer from depression Physical: 49% have one + chronic conditions 19

21 Options A. Provider/Industry Initiatives: IOM Study Nursing Homes Wellspring Home & Community-Based Initiatives Visiting Nurse Service of New York Work:» Redesigning job Recruitment & Retention:» Strengthening training» BSN Internship program» Improving paraprofessional benefits Support:» Mentoring» Giving employees voice 20

22 Options, continued B. Policies 1. Formal Caregivers: Federal Level: Nursing home staffing ratios Public disclosure of quality indicators State Level: Wage and benefit pass through Training Career advancement Transportation reimbursement 21

23 Options, continued 2. Policy Strategies for Informal Caregivers: Financial incentives Tax breaks Consumer Directed Options Cash and counseling model Supportive Services Respite Care Information Assistance with access 22

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