Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

State Long-term Care Programs: Balancing Cost, Quality, and Access

Workforce Shortages


Robyn I. Stone, Dr.P.H., Executive Director, Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, Washington, DC.

Edward S. Salsberg, M.P.A., Executive Director, Center for Health Workforce Studies, State University of New York at Albany, Renssalear, NY.

Robyn Stone, Director of the Institute for the Future of Aging Services, and Edward Salsberg, Executive Director of Center for Health Workforce Studies, suggested that multiple factors contribute to the challenge of maintaining an adequate workforce. These factors include:

  • Competition from other higher paid positions.
  • Response lags in the educational system.
  • Rising demand.
  • Decreased supply of workers due to an aging workforce.
  • Low societal value for caregiving.
  • Reimbursement policy.
  • Welfare policy.
  • Immigration policy.
  • Expanded career choices for women.

Maintaining a workforce must also deal with the demanding nature of the work, low wages, job design and working conditions, paperwork, and poorly trained managers. Dr. Salsberg offered nine strategies to address the workforce shortage and improve quality:

  • Assure competitive wages and benefits.
  • Invest in worker education and training.
  • Use Medicaid payments to support workforce development.
  • Test new job design, education, and training strategies.
  • Support health and education sector partnerships.
  • Support career ladders.
  • Increase the diversity of the workforce.
  • Improve management and supervisory skills.
  • Support technologies that assist workers.

Dr. Stone emphasized that ongoing research highlights the relationship of worker training and outcomes. Dr. Stone also discussed strategies implemented by States to maintain the workforce such as:

  • Wage pass through.
  • Shift differentials.
  • Providing access to health insurance coverage.
  • Linking increased reimbursement to outcomes.
  • Creating career ladders and increased training opportunities.

States are also using consumer directed models to expand the pool of workers as consumer themselves recruit and train family members, neighbors, and friends to provide care.

Additional Resources

Super N. Who will be there to care? The growing gap between caregiver supply and demand. Washington (DC): National Health Policy Forum, George Washington University; 2002 Jan.

Stone RI, Weiner JM. Who will care for us? Addressing the long-term care workforce crisis. Washington (DC): The Urban Institute and the American Association of Homes and Services for the Aging; 2001 Oct.

Yamada Y. Profile of home care aides, nursing home aides, and hospital aides: historical changes and data recommendations. Washington (DC): Gerontological Society of America 42(2):199-206; 2002 Apr.

Health care employment projections: an analysis of Bureau of Labor Statistics occupational projections, 2000-2010. Rensselear (NY): The Center for Health Workforce Studies, University at Albany; 2002 Jan.

Salsberg E. Assuring an adequate supply of health workers to provide high quality care to America's seniors. Miami (FL): Testimony to The Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century; 2002 Jan 14.

Reinhard SC, Barber PM, Mezey M, et al. Initiatives to promote the nursing workforce in geriatrics. Washington (DC): John A Hartford Foundation; 2002.

Previous Section Previous Section         Contents         Next Section Next Section

The information on this page is archived and provided for reference purposes only.

AHRQ Advancing Excellence in Health Care