Long-term care, or LTC, is “…the care you may need if you are unable to perform daily activities on your own. That means things like eating, bathing, dressing, transferring and using the bathroom,” (Genworth.com). LTC includes both medical and non-medical support, and is provided to anyone in need, not just the 65+ population. The long-term care workforce includes nursing assistants, home health and home care aides, personal care workers, and personal care attendants (Institute for the Future of Aging Services). However, physicians, nurses, administrative staff, and informal caregivers are also included in this workforce (Leadingage.org).
With the increasing presence of aging baby boomers and a retiring workforce, “The US will need to hire 2.3 million new health care workers by 2025 in order to adequately take care of its aging population, a new report finds,” says CNN. While this may speak of the healthcare workforce shortage as a whole, the long term care workforce shortage is a large part of the overall picture. According to this article by CNN, home health aides, which are a large component of the long-term care workforce, are projected to suffer the highest shortage rate of all healthcare professions by 2025. They were projected to be short nearly 450,000 workers, according to the article. In addition, their shortage far exceeds the other three professions listed in the study. The next highest, with a projected shortage number of 98,700, are medical and lab technicians and technologists. They are followed closely by nursing assistants, (who are also primary workers in the long-term care workforce), with a projected shortage of 95,000 workers. At 29,400, nurse practitioners come in last of the top four healthcare workforce shortage projections.
There are a number of factors contributing to the LTC workforce shortage. Low wages are a considerable contributing factor. Home health aides make up one of the larger portions of the LTC workforce and, according to Salary.com, they make an average of $12 an hour in the United States as of October 2019. Combine this with the fact that the job itself is strenuous and taxing, recruiting and retaining workers in this field is extremely challenging. According to this LTC workforce commission report by the Institute for the Future of Aging Services, there are more occurrences of accidents and injuries in LTC than are found in the construction and mining industries. The report also adds, “ One national study of assisted living reported annual turnover rates of about 40 percent among personal care workers and nurse aides.” In addition to poor wages, job dissatisfaction contributes to the high turnover rates in this field. However, one of the top, if not the top reasons direct care paraprofessional workers don’t leave their jobs is due to their relationships that are formed between them and the older adults under their care. Amongst these workers, those who feel that their supervisors appreciate them and take the time to listen to them are more likely to stay in their position, the report shares.
There are numerous other reasons why recruiting and retaining workers into LTC is challenging. One reason, according to the report, is the negative stigma that surrounds nursing homes. Poor human resource practices are also a large complaint made by workers in LTC. Many direct care staff feel their supervisors and managers aren’t adequately communicating with them or listening to their needs. Many feel “powerless to change their work environment.” Furthermore, the report discusses the lack of education and training, saying, “Most direct care paraprofessionals appear to learn what is expected of them and how to do their jobs after they have been hired. As a result, large numbers are unprepared for the demands placed upon them and leave their jobs within the first few months.” The disconnect between the training for the job and the job itself falls on the responsibility of both the employer and the training provider. This isn’t to say that recruitment campaigns must highlight every negative aspect of LTC work in order to set realistic expectations for incoming workers; rather, the onboarding process and subsequent training must realistically reflect the expectations and roles of the job so that new employees feel prepared and competent.
The report also shares an unsettling explanation for why paraprofessionals are more difficult to recruit and retain in the LTC workforce. They say:
The dilemmas peculiar to the recruitment and retention of the paraprofessional workforce are perhaps the most complex and difficult to resolve. Wages are not adequate to support young families with children. The job is often not well-designed, creating inefficiencies, unnecessary job burdens and subjecting occupants to high rates of injury. There are few opportunities for career advancement. Supervision is poor or non-existent. In addition, low unemployment rates for all entry-level personnel, coupled with increasing levels of education among minority populations, provide this labor pool with far more choices than low-income women have had in the past.
There are clearly barriers on nearly every level that are prohibiting job satisfaction. With complex, multi-faceted problems such as this calls for various specialized and innovative solutions. There are many avenues to take in order to attempt to solve the numerous complex issues surrounding the LTC workforce crisis. The LTC workforce commission report suggests a few:
- Modernize the image of the long-term care industry
- Target information on long-term care careers to post-secondary education and professional schools
- Develop effective long-term care leaders and managers
- Invest in information technology to reduce paperwork burdens in long-term care settings
- Promote long-term care employers’ self-assessment of working conditions
- Improve federal fair labor standards/other mandated worker protections for long-term care personnel
- Develop pathways to career advancement in facility-based and home and community care settings
- Establish “Center(s) on long-term care leadership, management and supervisory innovation”
- Make education and training opportunities more accessible, particularly in rural areas
- Improve medical directors’ performance
The solutions suggested in the report are not all listed here due to the large quantity of them. However, it is clear that there are many ways to help solve the LTC workforce crisis. Luckily, many healthcare workforce development initiatives have joined in the effort to implement many of these solutions. Health WorkForce New York is a non-profit organization dedicated to improving access to healthcare in under-represented and underserved areas across New York State and beyond. If you are interested in advancing your LTC services, contact us today to see how we can help.
According to the National Institute of Health (NIH), 80% of the landmass in the United States is considered rural or frontier and is home to approximately 50 million people, making up roughly 15% of the nation’s population in 2012 (World Bank). Rural residents experience a variety of disparities, including those in economic growth, income, and the poverty gap compared to urban or metropolitan communities. In addition to these disparities, healthcare providers are few and far between, leaving both patients and providers to travel long distances to get to an office, clinic, home, or a hospital. In addition to the distance barrier, many rural residents do not have access to transportation, and seeing as public transport is not common in rural regions, many simply lack the means and resources to access the healthcare they need (NIH; RHIhub).
A large contributing factor to the lack of healthcare access in rural United States is the shortage of healthcare workers in those regions. In metropolitan regions, there are 33.3 physicians for every 10,000 people. In nonmetropolitan, or rural regions, there are 12.7 physicians for every 10,000 people (RHIhub). Additionally, there are 92.4 registered nurses for every 10,000 people in metropolitan areas compared to 64 per 10,000 people in nonmetropolitan areas.
In 2015, 95.1 out of 100,000 people in nonmetropolitan areas died from cancer in New York State, compared to 71 per 100,000 people in metropolitan New York. There is also data that shows that death due to heart disease in New York State is much more prevalent in nonmetropolitan areas than in metropolitan.
According to peoplescout.com, of all the rural counties in the United States, 77% of them are suffering from a primary care physician shortage. In addition, they also share that 60% of the nursing shortage is occurring in rural regions.
There is clearly a high need for more healthcare providers in rural areas. Unfortunately, successful recruitment and retention initiatives are lacking. There are a number of reasons many healthcare providers choose not to practice in rural settings but there are just as many, if not more, misconceptions about rural work and lifestyle. It is clear that recruitment strategies need to address both the true concerns and misconceptions in order to successfully bring an adequate number of healthcare providers into rural communities. Recruitment efforts need to be multi-tiered; peoplescout.com says, “Economic, educational, professional and cultural dynamics affect the clinical talent shortages in rural areas.” All of these areas, and others not listed, also need to be addressed.
There are a number of recruitment strategies organizations implement now. Some of them include:
- Loan-repayment assistance for recent graduates
- Having rural healthcare representatives present at conferences, networking events, and trade shows
- Promoting rural communities and rural lifestyles
- Boosting benefits and incentives packages
- Promoting rural college healthcare programs (this includes bringing in students as well as staff)
This is a very small sampling of current recruitment strategies, however, there are many more out there and more are being developed and implemented today. In a survey conducted by Jackson Physician Search, “Community Culture” was the top reason physicians participating in the survey chose to work in a rural setting. “Compensation” came in as the second highest reason. It is clear that studies like this one are invaluable to actualizing recruitment strategies. Emphasizing the enhanced quality of work in rural healthcare settings due to their unique culture should not be overlooked as a useful strategy. Compensation as a player in recruitment is clearly an obvious shoo-in with great potential for success.
Loan-repayment assistance for recent graduates can be an incredibly successful recruitment strategy. Many students, particularly with medical or healthcare degrees, graduate in a lot of debt. Money can be a great incentive and the possibility of alleviating loan-repayment stress can be a deciding factor. Peoplescout.com shares three well-known loan-repayment assistance programs:
Representing rural healthcare at various events can be a great way to educate others who may not be aware of the high need for rural healthcare providers. It is entirely possible that many healthcare workers haven’t even considered employment in rural communities. More directly, rural representatives can, in person, promote their own organization and community. Building connections and expanding networks can also be beneficial in the long run for bettering rural funding, favorable policy changes, and addressing misconceptions through word-of-mouth. Representatives can also meet medical students and build a good rapport, putting rural on their radars. There are a lot of studies that support the claim that face-to-face interactions are far more successful than any other interaction (e.g. email, social media, etc.) This Washington Post article says, “Organizational behavior experts argue that face-to-face meetings are the best way to capture a person’s full attention, cutting through the multi-task tendency that focuses on too many things at once.” Having rural healthcare representatives at these networking events and conferences can be highly successful because it’s more direct and engaging, and thus, more memorable.
There are a number of ways to promote rural lifestyle. Many recruiters know that in order to successfully promote a job (in this case, rural healthcare), the community and lifestyle also need to be addressed. There are a lot of negative associations with rural America. High poverty rates, high obesity rates and other health concerns, “brain-drain” (skilled professionals moving out of rural areas and into urban centers en masse), lack of public transportation, fewer local amenities, and small-town social dynamics. While all of these elements should be seriously considered, there are so many positive characteristics of rural life. Some include having a closer relationship to nature and outdoor activities (running, swimming, hiking, camping, horseback riding, etc.), raising a family in a home with a yard, benefits of local farms (farmer’s markets, fresh food, farm-to-table restaurants, and harvest events such as pumpkin patches and apple picking), and tight-knit communities where impact is more easily seen. Some studies, like the one referenced in this article say that while high school graduates may leave their rural towns and go into cities, many return in their later years. The article says that in one Minnesota study, many “newcomers” moving into rural areas were professionals, “who were moving to smaller towns to improve their quality of life.” For those looking to live a quieter, and in some ways slower, lifestyle, rural is a good match. Promoting rural lifestyle strategies can range from boots-on-the-ground classroom visits at schools, digital and social media efforts, college programs highlighting rural opportunities, face-to-face discussions at networking events, and partnering with tourism agencies and Chambers of Commerce.
Similar to the loan-repayment assistance strategy, there are other benefits and incentives packages that could be promoted in strategic ways. This includes rural healthcare employers promoting various sign-on bonuses, relocation assistance, insurance benefits, assisting in paying for continuing education, retirement packages, sick leave, and low-interest home loans to name a few. Many rural hospitals and healthcare facilities are providing benefits and incentives like these. However, it is important to note that this strategy alone will not solve the rural healthcare shortage (medicaleconomics.com).
Promoting healthcare programs in rural colleges is another great recruitment strategy. Students who train in rural settings are more likely to stay rural. This is due to the fact that rural practices tend to differ from urban practices. Professionals who train in rural settings know what to expect and how to navigate the rural healthcare field with less of a learning curve than their urban counterparts. Similarly, healthcare professionals who grew up rurally and went to school in an urban setting are more likely to return to their hometown or another rural community (medicaleconomics.com). Another approach to increasing students in rural healthcare programs is to shift admissions focus, which tends to lean toward accepting the elite, or “best of the best” into medical programs, to accepting students with rural backgrounds and others who possess characteristics that would fit well in a rural healthcare setting (RHIhub; medicaleconomics.com). Some of these characteristics include: adaptability, resilience, reflective practice, and collaboration. With the combination of expanding who “fits” into a medical program and promoting rural programs, this will bring more rural students into these programs, which will then lead to a higher likelihood of those students returning to rural communities for work.
Rural health recruitment strategies not discussed in this article are still worth considering. Any efforts made to recruit healthcare providers into rural communities are extremely important. The need for healthcare workers in rural America is dire and only expected to get worse. A good approach for combating this shortage is to implement more than one strategy at once. Health WorkForce New York specializes in recruitment and retention initiatives. Our mission is to improve the quality of healthcare in underserved and under-represented communities. Our strategies are multi-pronged, combining boots-on-the-ground strategies with digital media, pipeline programs, regional campaigns, and rural immersion programs. If you’re interested in rural recruitment solutions and strategies, please don’t hesitate to contact us.