Long Term CareLong Term CareBetween 2018 and 2028, a projected 8.2 million jobs in the direct care workforce will open. The home care workforce is projected to add one million jobs by the end of the decade, more than any other occupation in the U.S. Four and a half million job openings will be a result of increased demand, workers moving into other occupations and workers exiting the labor force. Additionally, many states report worsening labor shortages during the pandemic. An estimated 420,000 direct care workers left the nursing home workforce over the last two years. For all direct care workers, the national annual turnover rate is estimated to be between 40 and 60%, with home care agencies reporting even higher rates, from 65-89%. The U.S. could experience a shortage of 151,000 direct care workers by 2030 and a shortage of 355,000 workers by 2040.
Individuals who are not usually attracted to long-term care jobs, such as high school students and displaced and post-retirement age workers, could be encouraged with the right incentives from government and the right messaging from community agencies. For example, a long-term care council in Pennsylvania recommended that the commonwealth implement incentives — such as loan forgiveness, tuition assistance and academic credit — to encourage college students to enter the direct care workforce. Apprenticeships and other paid work-based learning opportunities can recruit workers by removing training costs as a barrier. Such programs create more coordination across state agencies focused on employment, education and workforce development.
States are also developing additional strategies for recruiting and retaining workers.
Alabama legislators in 2024 passed legislation to create the Alabama School of Healthcare Sciences, a tuition-free public high school that is set to open in fall 2026. Gov. Kay Ivey had prioritized the concept of a state-funded health care high school since 2023 as an important part of the state’s workforce development strategy. At least 200 students are expected to enroll in the school, which will be located in Demopolis.
Georgia legislation creates a 12-month provisional practice allowance for military medical personnel while a license application is pending, creates a new advanced practice registered nurse license and establishes a new licensing system for APRN licenses.
Illinois legislation creates a Certified Medication Aide Program run by the Department of Public Health and requires that a registered nurse be on duty and present in the facility to delegate and supervise the medication administration during delegated times. It requires the department to submit a report regarding patient safety, efficiency and errors no later than one year after the full implementation of the program.
More than 60 Nebraska organizations representing many different sectors including health care and long-term care in 2024 announced broad, shared support for updating outdated federal immigration laws to support communities. The recommendations also include one to make state-level investments in community infrastructure, including affordable housing, quality and affordable child care, transportation, and other policies aimed at valuing and retaining the talents of both longtime and new residents.
Legislation in New Hampshire defines the position of Certified Assisted Living Medication Aide (CALMA) under the Nurse Practice Act (2024), provides for certification as a CALMA through the office of professional licensure and certification, and authorizes a CALMA to administer medication to individuals in specified residential settings. The bill also makes an appropriation to the Department of Health and Human Services, state Office of Rural Health, state loan repayment program to qualified nursing professionals, and directs the department to provide a report to the Legislature on a budget proposal for a student loan forgiveness program that would cover nurses who do not qualify for the state loan repayment program.
Pennsylvania required the development of a medication aide training program for an individual to become a certified medication aide, which may be offered by a long-term care nursing facility, and established the minimum training requirements for the position.
Tennessee allows unlicensed persons who have completed a competency-based training program, and who are employed by certain personal support service agencies licensed under law relative to mental health, substance abuse, and intellectual and developmental disabilities, to administer certain medications to individuals who are incapable of self-administration in the individual’s home.
Another Tennessee bill authorizes a medication aid to administer oral or topical medications prescribed with a nursing designation authorizing or requiring administration on an as-needed basis, regardless of whether a nursing assessment of the patient has been completed by a licensed nurse before administration; removes the prohibition against a medication aide administering medications delivered by aerosol/nebulizers or metered hand-held inhalers without spacers.
Virginia legislation added assisted living facilities to the list of eligible health care employers for which a health care practitioner licensed, certified or registered in another state or the District of Columbia may temporarily practice for one 90-day period. That is provided that the practitioner is contracted by or has received an offer of employment in the Commonwealth from the health care employer and certain other conditions are met.
Colorado and Texas partnered with ADvancing States and tech firm Altarum to create customizable online platforms for direct care workers to access tailored training, resources, and job matching services.
Massachusetts partnered with Northeastern University to create an employment website to connect nursing homes with potential job candidates.
Minnesota launched Direct Support Connect, a statewide job board that helps consumers find direct care workers and workers find employment.
Minnesota established a long-term care workforce grant program to provide specialized services and supports to new Americans to enter the long-term care workforce. $28,316,000 onetime appropriation available until 2027.
Nebraska (2024) released over $500K in mini-grants to HCBS providers to provide training to enhance the current workforce and expand the availability and quality of services.
New York’s New Jewish Home has a Geriatrics Career Development Program for high school students and a three-month program for disconnected young adults, ages 18-24, who are not enrolled in school and unemployed.
North Dakota allowed the Department of Health and Human Services the ability to employ staff that can be deployed to health care facilities, including long-term facilities, in order to address staffing shortages.
Washington exempted long-term care workers with a certificate expired for less than five years who is seeking to renew it from annual continuing education requirements while the certificate is expired.
Washington joined the Multistate Nurse Licensure Compact, allowing RNs and LPNs with a multistate license to practice in WA or remotely from the provider’s home state or another state within the licensure.
Wisconsin’s Certified Direct Care Professional (CDCP) program includes a job platform, WisCaregiver Connections, that connects community-based employers with CDCPs. CDCPs will be able to display their badge of achievement in resumes, email, and social media platforms to demonstrate their expertise. A CDCP registry has also been created to list all CDCPs and their achievements. The registry will be accessible to employers and colleagues.