Strengthening the Direct Care Workforce
for Long-Term Services and Supports
Suggested Approaches From a National Panel of Experts
In this regard, panelists discussed the importance of continuing to expand consumer-directed care programs in which persons requiring long-term care in the community can directly hire and pay their helpers, including family members. This approach gives consumers more control over their care arrangements. Being “hired” also provides family caregivers with much needed financial compensation, especially when their earnings in the paid workforce are diminished because of caregiving responsibilities or when they make financial expenditures related to the care recipient's needs. Following a discussion about various options under consumer-directed care, it was suggested that the most attractive option for some family members was getting direct cash benefits under a flexible individual budget. In fact, a recent national survey of family caregivers reported that their top preferences for programs or policies were tax credits and payment for the care they give (National Alliance for Caregiving, 2009). These could include providing refundable tax credits to help cover families' long-term-care costs as well as broadening the applicability of the Dependent Care Tax Credit to care recipients who do not live with the taxpayer.
Programs and incentives that transition former family caregivers into the direct care workforce were also suggested by panelists. Yet, some panelists felt this was a limited pool because former caregivers are often “burned out” and, if they are looking for employment, are likely to be seeking more lucrative opportunities. Another consideration related to the potential supply of family caregivers is the increase in informal caregiving by peers, non-kin, and fictive kin, especially in light of recent demographic changes, such as the entry of more women into the workforce, decreased birth rates, increased life expectancy, and the geographic dispersion of families. Informal caregivers could also be supported and encouraged through mechanisms such as caregiving cooperatives, community caregiver associations that mentor individuals new to caregiving, and easily accessible sources of caregiving information provided by ADRCs.
With respect to improving the recruitment and retention of family caregivers, panelists discussed approaches such as providing funds for home and environmental modifications to accommodate disabled relatives more easily in their own homes. Similarly, it was suggested that funds be made available for families to purchase assistive devices and associated training to facilitate bathing, lifting, transferring, and other care tasks, which make the work less physically demanding and safer for both the caregiver and care receiver. In addition, panelists recommended an increase in funding for services specifically directed toward caregivers, particularly respite services with 24-hour availability. Major increases in funding for the National Family Caregiver Support Program were also called for and seen as critical to supporting and retaining family caregivers.
Some panelists' suggested approaches for supporting employed caregivers included the following: having geriatric care managers help caregivers develop strategies to support care receivers while caregivers are at work; educating employers about caregiving issues such as the importance of flexible work schedules; and expanding the Family and Medical Leave Act (FMLA) and other paid leave policies at the federal and state level to promote wage replacement. For example, those caring for siblings, in-laws, domestic partners, and/or grandparents could become eligible under FMLA, and the threshold for coverage of private employers could be reduced from the current 50 employees to 15-25. Also with respect to the FMLA, ADRCs, SUAs, and AAAs could play a role in education about individuals' rights under the Act.
Approaches to Increase the Supply and Retention of Family Caregivers
2.1 Continue supporting expansion of consumer-directed care programs; promote peer-to-peer care and allow spouses, non-kin, and fictive kin to qualify as paid caregivers.
2.2 Identify ways, in partnership with the construction trades, home remodelers, HUD, and technology companies, to fund home remodeling, home additions, and installation of assistive technologies that enable informal caregivers to house and care for persons with disabilities.
2.3 Pursue strategies to expand the Family and Medical Leave Act that will better accommodate the needs of family caregivers and support the development and implementation of training programs for ADRC, SUA, and AAA staff so they can better educate persons about their rights under the Act.
2.4 Pursue strategies to amend the tax code to include Caregiver Tax Credits to ease the financial burdens of caregiving by offsetting both direct care expenses (e.g., food, clothing) and indirect expenses (e.g., lost wages).
2.5 Conduct demonstration and evaluation studies of new care models in which persons can serve as unpaid caregivers and bank their work hours for later use when they or their family members require care.
2.6 Encourage the Aging Network to foster and support community caregiver associations that mentor those new to caregiving and take advantage of the latest technologies to supply on-going information and support to family caregivers, possibly through ADRCs.
2.7 Increase funding for the National Family Caregiver Support Program to enhance all service components, including respite services with 24-hour availability.
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