6 Ways to Combat the Workforce Crisis in Home-Based Care

As Congress debates the merits of President Joe Biden’s American Jobs Plan, senior care experts are laying the groundwork for why home-based care provisions should be included in it — and why even more needs to be done after.  

Specifically, that home-based care provision is $400 billion to fund home- and community-based services. That influx of cash would theoretically help build out a more steadfast caregiver workforce in the U.S.

As the provision is weighed, the advocacy organization LeadingAge has released a report on six strategies it has developed — alongside its research partners — to improve long-term care. Those strategies include increased compensation for direct care professionals, more training, extending the caregiver pipeline and more.


“Care workers like nursing assistants, personal care aides and home health aides are the heart of aging services,” Katie Smith Sloan, the president and CEO of LeadingAge, said in a press release. “The COVID pandemic shed new light on how valuable these professionals are, but also made clear that America does not have the infrastructure for aging services that we need. This vision sets out a path toward the sustainable, reimagined workforce of professional caregivers that our nation needs to ensure better care for millions of older Americans.”

Washington, D.C.-based LeadingAge represents nonprofit home-based care agencies and other aging services providers. Researchers from LeadingAge Long-Term Services and Supports (LTSS) Center at UMass Boston aided the effort to design the strategies published in the report.

In addition to the three previously noted strategies, the others in the report are facilitating career advancement, preparing universal workers and reforming the LTSS financing system.


“Professional caregivers provide support to 20 million older adults, but many more are needed as the number of older Americans surges,” Robyn Stone, the SVP of research at LeadingAge and co-director of the LeadingAge LTSS Center at UMass Boston, said in the press release. “Filling these openings with qualified caregivers depends on our ability to professionalize the direct caregiver workforce.”

Direct care workers are not treated or compensated as professionals, the report argues. Taking these six steps would create a “direct care workforce that is professionalized.”

Six steps to a professional workforce

In order to expand the pipeline of caregivers, two things need to happen, according to LeadingAge: nontraditional workers need to be recruited into the field and immigration policies need to be altered to increase the amount of foreign workers available.

Nontraditional workers are individuals that historically would not be thought of as direct care workers, such as high school students, displaced workers from other fields and retirees who still want to work.

Immigrants already make up a significant percentage of caregivers in the U.S., but considering the need, immigration reform needs to take place, the report suggests. Oftentimes, immigrants who may be undocumented are fearful of backlash if they enter the field.

Enhancing education and training for professional caregivers has also been a need for a long time. When caregivers are trained in a more specific way, they enjoy their jobs more and provide better patient outcomes.

Training and education leads to better patient and caregiver satisfaction, both of which should be goals for any agency.

LeadingAge also believes that caregivers should be able to view their profession as more of a career than just a job. Allowing them to become condition-specific specialists or take on more advanced roles as they get more experienced is a way to do that.

Ideally, that would come with increased compensation as well, which is another one of the pillars of LeadingAge’s vision for the future of LTSS.

And while specificity is a way to create careers, creating universal workers is another way to mitigate the shortage. More caregivers being able to work in nursing homes, assisted living communities and home- and community-based settings would create a workforce that’s ready for the future of health care in the country, according to the report.

Finally, LeadingAge believes that reform to the financing system in LTSS is due.

Relying only on Medicaid is not a feasible path forward, and thus, alternate funding sources should be explored. Workers in the state of Washington, for example, will soon be paying a small tax that ensures they will be able to pay for adequate senior care when and if they do need it.

Companies featured in this article: