Editor's Note: Senior housing and services providers will enter 2015 with many unanswered questions regarding their future. A new Republican majority in the U.S. Senate, an expanded Republican majority in the U.S. House of Representatives and the presence of Republican governors in more states will bring new perspectives to the political landscape. Controversial presidential executive orders related to immigration reform await resolution, and threatened governmental action could overturn some or all of the Affordable Care Act and the health insurance it provides to certain seniors and others. New payment models and regulations under consideration could alter the business climate for years to come. In this multi-part series, Long-Term Living takes a look at some of the top issues that those who serve older adults will face in the new year. This is part four. See the entire series here, or see the digital edition of the December 2014 issue for the print version of these and related articles.
The very youngest members of the Baby Boom, the generation that represents about one-third of the U.S. population, turn 50 Dec. 31. By 2050, the number of Americans needing long-term can will more than double, from 12 million to 27 million, notes the National Council on Aging. The country’s aging population, and its concurrently aging workforce, will make it more difficult for providers to recruit, replace and maintain workers just when their services will be in highest demand.
Some contend that the immigration reforms announced by President Barack Obama on Nov. 20—protecting as many as five million undocumented immigrants from deportation and giving work permits to some—would help increase the pool of legal workers available in the United States, potentially benefitting skilled nursing and other facilities serving older adults. The American Health Care Association (AHCA), for one, has advocated for immigration reform, testifying before Congress in March 2013 and calling for efforts to make it easier for immigrants to be legally employed.
Beyond immigration reform, however, aging services providers must find ways to address the staff-related challenges they face. National turnover rates for CNAs, LPNs and RNs working in nursing homes, assisted living communities and continuing care retirement communities average 25 to 35 percent, according to data from the Hospital and Healthcare Compensation Service. RNs average hourly pay rates in the upper $20s, LPNs in the lower $20s and CNAs in the lower to mid $10s, according to the service.
Long-term care employees responding to a recent Shriver Report poll said that the most helpful actions employers could take would be increasing pay and benefits, providing up to 10 days of paid time off to cover sickness in themselves or a family member, and providing paid time off after the birth of a child, to care for a seriously ill family member or to recover from their own serious illness.
“If we don’t do something to attract and retain people for the future, then the direct care workers, especially, are going to be in short supply and high demand,” says Larry Minnix, president and CEO of LeadingAge. The organization, he adds, has advocated for living wages, good benefits and development opportunities for workers—and reimbursement to cover them. “Seventy percent or so of our costs in nursing home care are people,” he says. “And staffing is still the best proxy for quality. So we have advocated for policy that will directly reimburse us for those costs.”
The work is hard but rewarding, Minnix says. A program for staff members similar to the National Health Service Corps program, which repays loans and provides scholarships to primary care providers and students who serve in rural or inner-city neighborhoods, would “incentivize people to come into our field for two years or five years and give us a try. If we get someone for six months, we’ve got a good chance to keep them for life. They make a career out of it,” he says.