Who Will Care for Our Us?

Report: More Information Needed on Home Health Aides and Direct Care Workers

America’s aging population is increasingly reliant on home health and other direct care workers but not nearly enough is known about this workforce, prompting fears the country may not be prepared for the health and demographic challenges of the future, according to a new report from the Government Accountability Office (GAO).

Direct care workers are responsible for providing the majority of paid hands-on care to millions of seniors and people with disabilities requiring LTSS.  However, reported high attrition rates and difficulties recruiting and retaining qualified workers have fueled concerns about shortages, particularly considering the expected growth in the elderly population.


Despite this concern, policymakers in Washington and the states lack the necessary data to help them assess the size of the problem. The Health Resources and Services Administration (HRSA), which is part of the Department of Health and Human Services, is responsible for monitoring the supply of and demand for health care professionals. However, according to the GAO report, it has failed to produce projections of the health care workforce or data limitations, which is necessary for policymakers to plan for the coming demographic and health care challenges.
“While policymakers and other stakeholders are aware of the challenges in recruiting and retaining direct care workers, their ability to develop relevant, targeted policies addressing these challenges has been hampered by gaps in data,” the GAO wrote in the report.
Federal data indicates 12.3 million Americans six years of age and older needed long-term services and supports (LTSS) in 2010 and the U.S. spent $337 billion on LTSS in 2014, about 13 percent of all personal health expenditures in that year. Medicaid and Medicare account for 66 percent of all LTSS spending, with private insurance and out-of-pocket spending accounting for the rest. There are approximately 3.27 million long-term direct care workers in the United States, about 21 percent of the total health care workforce.
However, while available data provides a broad picture of the direct care workforce, significant information gaps exist, such as a lack of information on attrition and independent providers. The report recommends that HRSA produce projections of the direct care workforce supply and demand, including home health aides and personal care aides who work in homes.
The HRSA agreed with the GAO’s recommendation to produce projections and said the National Center for Health Workforce Analysis is developing a fact sheet to report on demand projections for home health workers and nursing assistants.
Report: More Information Needed on Home Health Aides and Direct Care Workers | National Association for Home Care & Hospice