Will the United States have enough workers to help an aging population?

photo of an aging person's handsMore than 12 million Americans need assistance with routine daily activities, such as eating, dressing, bathing, and making meals. Direct care workers—home health aides, psychiatric aides, nursing assistants, and personal care aides—are the primary paid providers of the long-term care they need.

As the baby boomers age, there are concerns that there may not be enough long-term care workers to meet their needs. Today’s WatchBlog looks at what the Department of Health and Human Services could do to measure the severity of the problem.

Rising demand…

Many of the people who need long-term care are elderly, and the number of elderly Americans is growing—by 2030, 20% of the U.S. population is expected to be 65 or older.

Will there be enough people to help them as they age?

The nation’s health workforce provides a range of services to the old and young alike. Roughly 20% of the health workforce are direct care workers who provide long-term care, but it is unclear to what extent these numbers include what is referred to as the “gray market” of providers—for example, people hiring friends or neighbors to help with daily activities.

Direct Care Workers as a Percentage of the Total Health Workforce, 2014

(Excerpted from GAO-16-718)

Regardless of type of hiring situation, recruiting and retaining more home health workers can be difficult. Wages are generally low, averaging between $10 and $13 per hour in 2015.

…but what about supply?

The Health Resources and Services Administration, an agency within the Department of Health and Human Services, is responsible for monitoring the supply of and demand for health care professionals.

The agency has developed some information on direct care workers, but it hasn’t produced actual supply and demand projections for the direct care workforce.

The data they need to make these projections accurately is hard to come by. For example, it’s difficult to measure how quickly the workforce turns over, or the size of the gray market. It’s also hard to know how many people will need long-term care.

However, these projections are critical: the nation needs to know more about the long-term care workforce to ensure there will be enough direct care workers to meet demands. With reliable projections, policymakers will be better equipped to develop relevant, targeted policies—designed, for example, to impact recruitment, retention, or training—and to measure the impact of these initiatives.

That’s why we recommended that the Health Resources and Services Administration take the steps necessary to improve the data about the direct care workforce.

You can find out more about the direct care workforce in our report. Or listen to Kathleen King, a director in our Health Care team, share what her team found:


• Questions on the content of this post? Contact Kathleen King at kingk@gao.gov.
• Comments on GAO’s WatchBlog? Contact blog@gao.gov.

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