Strengthening the Direct Care Workforce
for Long-Term Services and Supports
Suggested Approaches From a National Panel of Experts
After all recommended approaches were compiled into a matrix, panelists were asked to rank them in relation to their perceived priority. In all, six out of the eleven panelists completed the task of ranking the top priorities among the total of 33 suggested approaches noted in this document. The results in Table 1 show approaches that at least two panelists considered a priority.
The approaches that were most frequently endorsed (by four panelists) were:
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).
6.1—Support demonstrations and evaluations of specialized DCW training programs that enable them to assist older adults' in managing chronic conditions and determine the impact on clients' health outcomes.
The next most frequently endorsed priorities (three panelists each) were:
7.1—Provide information upon request to the National Health Care Workforce Commission regarding development, dissemination, and application of evidence-based, best-practice programs designed to advance the training, support, and retention of DCWs and informal caregivers.
7.6—Collaborate with CMS on infrastructure grants designed to build the capacity of AAAs for the expansion of HCBS and for serving a private pay market and administering managed care programs.
It is interesting to note that these four priorities speak to support for family caregivers, both financially as well as through education and training; specialized and evidence-based training programs for direct-care workers; and the Aging Network's ability to evolve in response to new developments in the arena of home- and community-based services programs. In combination, these approaches have significant potential to enhance the capacity and performance of the long-term-care workforce.
Table 1. Suggested Approaches Endorsed as Top Priorities by Panelists |
Suggested Approaches |
Number of Panelists' Endorsements |
2. |
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 |
2.4 |
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). |
4 |
2.7 |
Increase funding for the National Family Caregiver Support Program to enhance all service components, including respite services with 24-hour availability. |
2 |
3. |
Approaches to Improve the Readiness of DCWs |
|
3.4 |
Consider a variety of partners to develop and implement recruitment and training programs for DCWs, including special apprenticeship programs targeted to HCBS; some of these may include Workforce Investment Boards, community colleges, Department of Labor, Department of Education, labor unions, boards of nursing, senior and disability advocates, advocates for immigrants, universities/centers of excellence, ADRCs, and United Way. |
2 |
4. |
Approaches to Improve the Readiness of Family Caregivers |
|
4.1 |
Support demonstrations and evaluations of hands-on training programs for family caregivers that include training on skills such as body mechanics, lifting, transferring, bathing, and use of assistive devices, and include them in AoA's toolkit of evidence-based training programs. |
2 |
5. |
Approaches to Improve the Readiness of Both |
|
5.1 |
Support demonstration-evaluation programs that build on core competencies to train family caregivers and DCWs jointly in order to promote shared understanding of their roles and new training programs for DCWs that enable them to educate family caregivers about safe and effective care techniques (e.g., lifting, transferring), possibly in collaboration with the Department of Labor. |
2 |
6. |
Approaches to Improve Outcomes for DCWs and Family Caregivers |
|
6.1 |
Support demonstrations and evaluations of specialized DCW training programs that enable them to assist older adults' in managing chronic conditions and determine the impact on clients' health outcomes. |
4 |
6.4 |
Incentivize provider organizations to implement workforce improvement practices, using OAA and/or Medicaid funding, and include measures of workforce improvement (e.g., decreased turnover, increased number of job advancements, fewer unfilled positions) in their reports to AoA. |
2 |
7. |
Health Care Reform and the CLASS Act |
|
7.1 |
Provide information upon request to the National Health Care Workforce Commission regarding development, dissemination, and application of evidence-based, best-practice programs designed to advance the training, support, and retention of DCWs and informal caregivers. |
3 |
7.4 |
Collaborate with CMS on investing in ADRCs and/or AAAs so that they have a significant role in care transition and care coordination models that emphasize family involvement and education around anticipated changes in caregiving tasks and demands. |
2 |
7.5 |
Collaborate with CMS on investing in ADRCs and/or AAAs to provide counseling and education about use of benefits under the CLASS Act. |
2 |
7.6 |
Collaborate with CMS on infrastructure grants designed to build the capacity of AAAs for the expansion of HCBS and for serving a private pay market and administering managed care programs. |
3 |
The panelists set forth a wide variety of programmatic, advocacy, and policy suggestions for the Aging Network's consideration as it works to improve the supply, readiness, retention, and outcomes for DCWs and family caregivers. The responses summarized in this report are indicative of the work that needs to be planned and implemented in order to fully equip the Aging Network as it expands home- and community-based long-term-care programs, and continues to build and support the direct-care workforce that delivers the bulk of long-term care.
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