Better Training, Career Development Needed for America’s Direct-Care Workforce

By 2034, all of America’s baby boomers will be over the age of 70, many living with complex health care needs and multiple chronic conditions.

A well-trained direct-care workforce will be critical to keeping those baby boomers safely in their homes as they age. Without one, experts predict, public and private insurers will struggle in meeting the population’s needs.

The Bipartisan Policy Center, a Washington, D.C.-based think tank that works to promote bipartisanship on key issues facing the United states, highlighted the need to support the country’s direct-care workforce in a report released on Thursday.


“We know that patients living with serious illness prefer to receive care in the home, rather than an institution like a hospital or nursing home,” Katherine Hayes, Bipartisan Policy Center’s director of health policy, said in a statement. “Creating training opportunities for our direct care workforce, such as personal care aides, will give them important new skills so they can continue to work in the home.”

There are more than three care workers for every retiree, according to current data from Bipartisan Policy Center. In 12 years, that number will decrease to two workers for every retiree, while baby boomers continue to age.

In its latest report, Bipartisan Policy Center made several recommendations for how care can be strengthening in the years to come.


For example, Congress should establish a grant program and direct the Administration for Community Living and the Health Resources and Services Administration to provide training grants for personal care aides and community health workers, Bipartisan Policy Center argues.

Additionally, the U.S. Department of Health and Human Services (HHS) should use existing authority to waive the requirement that providers who are working under direct physician supervision be in the same location when providing home-based evaluation and management and palliative care services to patients with serious illness, according to the think tank.

Another recommendation: the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) should identify and evaluate caregiver training models focused on specific chronic illnesses to determine under what circumstances they are successful and how they might be scaled.

Broadly, CMS should examine ways to improve the assessment of individual and caregiver needs and ways to adjust payments to reflect costs, according to Bipartisan Policy Center. Likewise, HHS should permit plans to use newly created authority within Medicare Advantage to support family caregivers with respite care services.

“Caregiving can be rewarding, but it can also be stressful,” Hayes said. “Without the proper support systems in place, caregivers and the individuals they care for can experience poorer health outcomes.”

Several home care companies have made the creation of career ladders a priority in effort to better recruit and retain workers. They include home care franchise company Senior Helpers, which has launched dedicated training programs for workers to become specialists is dementia care and other areas.

The Bipartisan Policy Center released a separate but related report in October as well.

The earlier report proposed several policy options to change Medicare payment and delivery models, while also calling for improved access to patient care through telehealth services.

CMS recently proposed a rule that would expand access to telehealth services. In a change the would, if implemented, go into effect in 2020, CMS floated the idea of allowing MA plans to cover telehealth benefits for both rural and urban enrollees, as well as in home settings.

Former Senate Majority Leaders Tom Daschle and Bill Frist are among the leaders of the Bipartisan Policy Center. Frist is the co-founder of Aspire Health, the nation’s largest non-hospice community-based palliative care provider. Anthem, Inc. (NYSE: ANTM) acquired Aspire Health in June.

For both home health aides and personal care assistants, the median annual wage in 2017 was about $23,000. Employment of home health aides and personal care aides is likely to grow 41% from 2016 to 2026, much faster than the average for all occupations, the U.S. Bureau of Labor Statistics projects.

Written by Robert Holly

Companies featured in this article: