While most states have seen an increase in the size of their home care workforce, the nursing home workforce has experienced a slight decrease, a new analysis shows. This growth and decline took place between 2009 and 2021.
The analysis comes from a study published Monday in the policy journal Health Affairs. The study examines trends in the long-term care workforce across the U.S.
Overall, the direct care workforce has seen risen from 3 million workers in 2009 to 4.6 million workers in 2019. Long-term care workers make up roughly one-fifth of the entire U.S. health care workforce.
Despite this overall growth, the increase has not been identical across settings.
Between 2009 and 2020, there was an increase of about 60 home care workers per 1,000 people with disabilities and a decrease of about 10 nursing home workers per 1,000 people with disabilities.
States such as New York, Massachusetts, and Washington, D.C., saw the most increases, with 207, 201 and 175 home care workers per 1,000 people with disabilities between 2009 and 2020, respectively.
The study does not directly evaluate what’s driving these trends, but seniors’ preference for aging in place and the broader shift to move health care into the home could be behind the increase, Esther Friedman, a research associate professor at the University of Michigan Institute for Social Research and one of the study’s authors, told Home Health Care News.
“There has been a push for several decades to move long-term care services away from institutions like nursing homes and into home- and community-based settings, when appropriate,” she said in an email. “People generally want to age at home, if they can, and programs like home- and community-based waivers, and other grants and financial incentives providing funding for home- and community-based services, have made that more feasible. These types of programs could be part of what is guiding the growth we are seeing in the home care workforce relative to the nursing home workforce.”
While it may seem that home-based care providers are gaining over nursing home operators, this doesn’t tell the whole story, according to Friedman.
“Did states that increased the size of their home care workforce also decrease the size of their nursing home workforce,” she said. “While we found some substitution, it wasn’t one-to-one. The home care workforce has been increasing at a substantially faster pace than the nursing home workforce has been declining. This suggests that the trends we are seeing are not solely due to nursing home workers moving into home care.”
The study also found that the gap between states with the largest and smallest home care workforces has only continued to widen, according to Friedman.
“Given the desire to age at home and recent efforts to support home-based care, we had expected the gap in the home care workforce size between states that started out with the largest home care workforce in 2009 … and those with the smallest to shrink with time,” she said. “We found just the opposite: The gulf between states with the largest home care workforce relative to those with the smallest has been widening over the observation period of this study.”
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