US PAS Workforce Library
The following is a list of PAS Workforce resources related to US. The list is provided and maintained by the National Clearinghouse on the Direct Care Workforce. Each citation contains an abstract and information about how to obtain the entire version.
Dawson, Steven L., and Rick Surpin. (May 2001). Direct-care health workers: The unnecessary crisis in long-term care. The Aspen Institute.
Abstract:
The authors examine the structure of long-term care, its financing, and the impact of the current labor crisis on the three key stakeholders: workers, providers, and consumers. The report recommends a sectorwide restructuring of long-term care, supported by new labor, welfare, and health care policies.
Obtain the Full Version
For information about ordering copies of this report, please contact the Clearinghouse at info@directcareclearinghouse.org or 718-402-4138.
Please note: There is a charge of $2 a copy for all orders of five or more, plus shipping and handling.
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/Aspen.pdf
Scanlon, William J. (May 2001). GAO testimony: Nursing workforce: Recruitment and retention of nurses and nurse aides is a growing concern. General Accounting Office.
Abstract:
In testimony to Congress, the General Accounting Office (GAO) provides a comprehensive analysis of current and future long-term care staffing issues. This report includes data quantifying the shortage of nurses and paraprofessionals across all states and identifying the race, ethnicity, gender, and age characteristics of the workforce; an analysis of critical factors affecting labor, including wages, working conditions, and changing demographics; and a survey of strategies that states are using to address the current shortage of workers.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/GAO_HELP_Statement.pdf
Wilner, Mary Ann, and Ann Wyatt. (September 1998). Paraprofessionals on the front lines: Improving their jobs; Improving the quality of long-term care. AARP.
Abstract:
This background paper explores the role of paraprofessionals in long-term care, highlighting the relationship between direct-care workers and their clients. After introducing basic demographic characteristics of the paraprofessional labor, the report assesses a variety of barriers to decent jobs and high-quality care, including staff shortages and high turnover; the association of caregiving with 'women's work'; inadequate supervision; and inadequate reimbursement keeping wages low. Includes an excellent list of references.
Obtain the Full Version
For information about ordering the full report,
please contact the Clearinghouse at info@directcareclearinghouse.org or 866-402-4138
Please note: There is a charge of $2 a copy for all orders of five or more, plus shipping and handling
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/Paraprofessionals_on_the_Front_Lines_ExecSum.pdf
Noelker, Linda S. (Spring 2001). Who will care for older people? Workforce issues in a changing society. Generations.
Abstract:
The articles in this special issue describe the nature and scope of the shortage of frontline workers in long-term care and make recommendations for strengthening this workforce. The three sections of this issue outline demographic issues and policy perspectives; address the particular problems of professionals in long-term care; and examine strategies for recruiting and retaining paraprofessionals, suggesting ways to increase job commitment, lower stress, and improve performance.
Obtain the Full Version
To get a copy of this article, go to:www.generationsjournal.org
Stone, Robyn I., and Joshua M. Wiener. (October 2001). Who will care for us? Addressing the long-term care workforce crisis. The Urban Institute and the American Association of Homes and Services for the Aging.
Abstract:
This report analyzes current and future labor shortages across long-term care by analyzing factors that impact the supply and demand of direct-care workers. These factors include public policies as well as workplace culture and practices. The report also summarizes recent public and private efforts to address recruitment and retention issues and to develop a qualified, stable frontline workforce.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/Who_Will_Care_for_Us_Report.pdf
Rehnquist, Janet. (November 2002). Nurse aide training. Department of Health and Human Services, Office of Inspector General (OIG).
Abstract:
A study of nurse aide training conducted by the Department of Health and Human Services Office of the Inspector General (OIG) finds that nurse aide training has not kept pace with nursing home industry needs, teaching methods are often ineffective, clinical exposure is too short and unrealistic, and in-service training may not meet federal requirements. The report is based on interviews with federal and state officials and 29 nursing homes. 92 nursing aides were interviewed, 889 nurse aides completed surveys, and 17 participated in focus groups.
Obtain the Full Version
Available on the web:
oig.hhs.gov/oei/reports/oei-05-01-00030.pdf
Dawson, Steven. (January 2003). Long term care financing and the long-term care workforce crisis: Causes and solutions. Citizens for Long-Term Care.
Abstract:
This paper examines the emerging 'care gap' in long-term care and the negative impact of staff shortages on the three primary stakeholders, consumer, providers, and workers. It recommends a national strategy--integrating both federal and state policy into a comprehensive system of long-term support and services--to address the direct-care crisis. Specific recommendations include: 1) Develop a national commitment to long-term care financing; 2) Make direct-care jobs competitively attractive by improving wages, training, opportunities for advancement, employee supports, improved use of technology, and accountability; and 3) Broaden supply by attracting younger and older workers, male workers, workers transitioning from public assistance, and new immigrants.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/CLTC_doc_rev1.pdf
Department of Health and Human Services and Department of Labor. (May 2003). The future supply of long-term care workers in relation to the aging baby boom generation. Department of Health and Human Services and Department of Labor.
Abstract:
This report notes that the nation will need between 5.7 million and 6.5 million long-term care nurses, nurse aids, and home health and personal care workers to meet the needs of baby boomers by 2050. It lists a broad range of federal programs that work toward 'developing a committed and quality direct care worker pool in a variety of long-term care settings.' The report lists four issues that need to be addressed in order to retain current workers and attract new ones: 1) Finding workers in new populations 2) Conducting effective initial and continuing education and training 3) Improving working conditions in terms of hours, paperwork, respect, and safety 4) Improving compensation, benefits, and opportunities for advancement.
Obtain the Full Version
Available on the web:
aspe.hhs.gov/daltcp/reports/ltcwork.htm
National Center for Health Workforce Analyses Bureau of Health Professions Health Resources and Services Administration (HRSA). (February 2004). Nursing aides, home health aides, and related health care occupations: National and local workforce shortages and associated data needs. Department of Health and Human Services.
Abstract:
This report on the growing shortage of direct-care workers notes that the supply of certified nursing assistants (CNAs) and home health aides is declining while demand is growing at a record pace. The report finds that the shortage shows no signs of improving, and that it is a matter of retention, not recruitment: the problem is high turnover due to low pay, too few opportunities for professional advancement, and other factors. The report is based on a review of eight key federal data sets, CNA registries in 45 states and interviews and focus groups with long-term care providers and state officials in four states. The report notes the problem of developing an accurate picture of the shortage, due to data limitations including exclusions, inconsistency of definitions, and categorizations that are in some cases excessively broad.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/RNandHomeAides.pdf
Anderson, Wayne L., Joshua M. Wiener, Angela M. Greene, and Janet O'Keeffe. (April 2004). Direct service workforce activities of the Systems Change grantees. RTI International.
Abstract:
In 2001 the Centers for Medicare and Medicaid Services (CMS) awarded Real Choice Systems Change (RCSC) Grants to states and other entities working to improve state long-term care systems. Twenty grantees began one or more initiatives to improve the recruitment and retention of direct service workers. This report focuses on the workforce initiatives of these 20 grantees, with an in-depth look at 7. The report strongly recomends that policymakers, providers, and consumers address workforce problems.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/CMSWorkforce.pdf
Available on the web:
www.communitylivingta.info/files/35/1708/CMSWorkforce.pdf
Dorie Seavey. (October 2004). The cost of frontline turnover in long-term care. Better Jobs Better Care.
Abstract:
This report details information known about the cost of turnover among direct-care workers. The author argues that it is important to track these costs and presents a framework for measuring them. Research findings indicate that: An expanded accounting model that includes direct and indirect costs provides the most accurate estimate of turnover costs; indirect costs, which tend to be overlooked, may be substantial; and the direct cost of turnover is at least $2,500 per frontline worker. The report offers recommendations for providers, policy makers, and researchers that are designed to improve overall understanding of the costs related to turnover and the effectiveness of various strategies intended to reduce those costs.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/TOCostReport.pdf
Harmuth, Susan, and Susan Dyson. (September 2005). Results of the 2005 national survey of state initiatives on the long-term care direct-care workforce. The National Clearinghouse on the Direct Care Workforce and the Direct Care Workers Association of North Carolina.
Abstract:
This is the fifth national survey of the direct-care workforce conducted by these authors. It examines public policy actions taken by states to strengthen the direct-care workforce, and updates information collected in prior surveys. Responses were received from 38 states, representing a 76 percent response rate.
Obtain the Full Version
For information or copies contact the National Clearinghouse on the Direct Care Workforce at info@directcareclearinghouse.org or 866-402-4138 (toll-free)
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/2005_Nat_Survey_State_Initiatives.pdf
Schindel, Jennifer, et al. (2006). Workers who care: A graphical profile of the frontline health and health care workforce. Robert Wood Johnson Foundation.
Abstract:
This chart book provides comprehensive employment data on frontline health and health care workforce occupations. It includes three parts: a view of the frontline workforce as a whole; occupational variations across the workforce; and in-depth occupational profiles that provide key information such as per capita employment, occupational growth rates, reported wage gains, and other trends. Long-term care workers such as nursing aides, home health aides, and personal and home care aides are among those profiled.
Obtain the Full Version
Available on the web:
www.healthws.com/graphics/chartbook.pdf
Pattison, Brian T., et al. (December 2006). States' requirements for Medicaid-funded personal care service attendants. Office of Inspector General (OIG), Department of Health and Human Services (HHS).
Abstract:
This report examines state requirements for personal care attendants and policies for oversight of those requirements. It finds significant variation, with 301 sets of attendant requirements nationwide. The six most common requirements are background checks, training, age, supervision, health, and education. However, states defined these differently. Frequency and scope of the review process also varied. The report concludes that more consistency or standardization may make monitoring attendant requirements less cumbersome and enhance quality assurance.
Obtain the Full Version
Available on the web:
www.oig.hhs.gov/oei/reports/oei-07-05-00250.pdf
(2007). NCSBN directory of nurse aide registries. The National Council of State Boards of Nursing, Inc. (NCSBN).
Abstract:
State contact information for nurse aide registries across the country are collected within this directory, compiled annually by the National Council of State Boards of Nursing(NCSBN).
Obtain the Full Version
Available on the web:
www.ncsbn.org/07_NA_Registries.pdf
Polzer, Karl. (March 2007). Assisted living state regulatory review 2007. National Center for Assisted Living.
Abstract:
This report summarizes the state laws and regulations that govern assisted living facilities, including requirements for staff criminal background checks and age minimums, CPR training, staff-to-resident ratios, and training requirements. It also provides contact information for each state's assisted living regulatory agency and offers brief commentary about regulations and legislation currently under consideration.
Obtain the Full Version
Available on the web:
www.ncal.org/about/2007_reg_review.pdf
Harrington, Charlene. (January 2008). Nursing home staffing standards in state statutes and regulations. University of California San Francisco, Department of Social and Behavioral Sciences.
Abstract:
This set of charts lists the state staffing standards for nursing homes in all 50 states and the District of Columbia. It summarizes the requirements for direct-care staff, as well as for licensed staff and caregiving staff overall; estimates the difference between the state requirements and the federal standard for facilities with 100 beds; and includes links to each relevant statute and regulation.
Obtain the Full Version
Available on the web:
www.nccnhr.org/uploads/HarringtonStatestaffingtableRevisedJan2008.pdf
PHI. (July 2008). State chart book on wages for personal and home care aides, 1999-2006.
Abstract:
This chart book provides information, based on data from the Bureau of Labor Statistics, on the wages received by personal and home care aides in all 50 states and the nation over a 7‐year period. The publication provides information on nominal and real median wages, a time‐series graph analyzing state wages, tables comparing wages across states, a national summary, and technical notes.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/PHI_State_Chartbook_PHCA_Wages_99-06.pdf
PHI. (July 2009). State chart book on wages for personal and home care aides, 1999-2008.
Abstract:
This chart book provides information, based on data from the Bureau of Labor Statistics, on the wages received by personal and home care aides in all 50 states and the nation over a 9‐year period. The publication provides information on nominal and real median wages, a time‐series graph analyzing state wages, tables comparing wages across states, a national summary, and technical notes.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/PHI_State_Chartbook_PHCA_Wages_99-08.pdf
(2009). State nurse aide training requirements, 2009. PHI.
Abstract:
This chart summarizes state requirements for nurse aide training programs that go beyond the federally mandated 75 hours of training.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/state-nurse-aide-training-requirements-2009.pdf
PHI. (December 2009). State-by-state projected demand for new direct-care workers, 2006-16.
Abstract:
This chart presents occupational employment projections for direct-care workers in all 50 states, as well as Washington, DC. The projections are organized into three categories: home health aides; nursing aides, orderlies, and attendants; and personal and home care workers. Overall, there were approximately three million direct-care workers employed in the U.S. in 2006; by 2016, however, an additional one million positions must be filled in order to meet the rising demand for direct care.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/State by State DCW Demand Projections 2006-16 FINAL rev.pdf
Polzer, Karl. (March 2010). Assisted living state regulatory review 2010. National Center for Assisted Living.
Abstract:
This report summarizes the state laws and regulations that govern assisted living facilities, including requirements for staff criminal background checks and age minimums, CPR training, staff-to-resident ratios, and training requirements. It also provides contact information for each state's assisted living regulatory agency and offers brief commentary about regulations and legislation currently under consideration.
Obtain the Full Version
Available on the web:
www.ahcancal.org/ncal/resources/Documents/2010AssistedLivingRegulatoryReview.pdf
PHI. (April 2010). Older direct-care workers: Key facts and trends.
Abstract:
This fact sheet presents data pertaining to the aging direct-care workforce, particularly home care workers. It shows that approximately 22 percent of all direct-care workers were age 55 and older in 2008; that percentage is projected to increase to 29 percent by 2018. The fact sheet uses data derived from the Census Bureau's Current Population Survey (CPS).
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/PHI Older DCW Analysis April 2010.pdf
PHI. (June 2010). Health reform facts 1: Workforce development and training opportunities for direct-care workers.
Abstract:
This fact sheet describes numerous ways that that 2010 health reform law may have a positive impact on the direct-care workforce. It describes several new workforce commissions, federal training grants, and workforce-development programs that will be created as a result of health reform. The fact sheet is the first in a planned series, published by PHI, detailing health reform's effect on the direct-care workforce.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/HCHCW HealthCare FactSheet1.pdf
PHI. (July 2010). Health reform facts 2: Pre-existing condition insurance plan.
Abstract:
This fact sheet explains the Pre-Existing Condition Insurance Plan (PCIP), a featured component of the federal health reform legislation signed into law in 2010. Uninsured Americans who have pre-existing health conditions will be able to more easily obtaining health coverage through the PCIP. Direct-care workers who have chronic health conditions, illnesses, or suffer from work-related injuries will especially benefit from the program.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/HCHCW HealthCare FactSheet2.pdf
(July 2010). State chart book on wages for personal and home care aides, 1999-2009. PHI.
Abstract:
This chart book compiles the median wages for personal and home care aides in each state between 1999 and 2009. It finds that the real median wage for such workers increased by only 0.6% during the decade covered. Additionally, 36 states paid wages that fell below 200 percent of the federal poverty level in 2009, up from 32 states in 2008. Data for the chart book was gathered from the U.S. Bureau of Labor Statistics.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/PCA_Wage_Chart_Book_1999_2009.pdf
PHI. (July 2010). Health reform facts 3: Small business benefits available to eldercare/disability services employers.
Abstract:
This fact sheet details several ways that national health reform, passed into law in March 2010, will help small businesses provide health insurance to their employees. For example, the law includes numerous tax credits that small businesses can take advantage of, as well as a federal grant program that will reward employers for establishing employee wellness programs.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/HCHCW HealthCare FactSheet3.pdf
Fremstad, Shawn. (January 2011). Implementing the coverage provisions of health care reform: What's at stake for direct care workers. Direct Care Alliance.
Abstract:
This policy paper outlines the provisions of national health care reform that will prove to be most useful to direct-care workers. Some of those provisions include an expansion of Medicaid, the creation of a Pre-Existing Condition Insurance Plan, and the establishment of health exchanges where Americans can purchase insurance. The brief also lists specific policies that workers and their allies should advocate for to insure that direct-care workers can take full advantage of health reform.
Obtain the Full Version
Available on the web:
blog.directcarealliance.org/wp-content/uploads/2010/12/PolicyBrief_7.pdf
PHI. (May 2012). America's direct-care workforce.
Abstract:
This fact sheet gives an overview of the direct-care workforce, describing job titles, responsibilities, worker demographics, wages, benefits, and the growing demand for workers.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/PHI Facts 3.pdf
(March 2011). Health care coverage for direct-care workers: 2009 data update. PHI.
Abstract:
This PHI fact sheet examines the rate of health care coverage among the direct-care workforce, breaking down the workforce by occupation, setting, and location. The report concludes with a discussion of the Affordable Care Act and its potential to improve the health coverage rate among direct-care workers.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/facts4-20110328.pdf
PHI. (August 2011). State-by-state projected demand for new direct-care workers, 2008-18.
Abstract:
This chart presents occupational employment projections for direct-care workers in all 50 states, as well as Washington, DC. The projections are organized into three categories: home health aides; nursing aides, orderlies, and attendants; and personal and home care workers. Overall, there were nearly 3.3 million direct-care workers employed in the U.S. in 2008. By 2018, however, an additional 1.5 million positions must be filled in order to meet the rising demand for direct care.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/statebystate-DCWdemand-20082018.pdf
(August 2011). State chart book on wages for personal care aides, 2000-2010. PHI.
Abstract:
This chart book compiles the median wages for personal care aides (PCAs) in each state between 2000 and 2010. It reports that PCA wages declined in 17 states between 2009 and 2010; overall, PCA wages for the entire U.S. crept downward slightly. The chart book also finds that real median wages for PCAs declined in 26 states between 2000 and 2010. Data for the chart book was gathered from the U.S. Bureau of Labor Statistics.
Obtain the Full Version
Available at the National Clearinghouse on the Direct Care Workforce website:
http://www.phinational.org/clearinghouse/download/PCAwages-2000to2010.pdf
(August 2011). Nursing home survey on patient safety culture: 2011 user comparative database report. Agency for Healthcare Research and Quality.
Abstract:
This survey contains data compiled from 226 nursing homes throughout the U.S. The data presents the opinions of nursing home staff regarding resident safety, the incidence of medical errors, and event reporting. Respondents are broken down by various characteristics, including job title, shift worked, and the extent to which they interact with residents. The category ''Nursing Assistant/Aide'' accounted for 35 percent of the survey's 16,000 respondents, the most of any occupational group.
Obtain the Full Version
Available on the web:
www.ahrq.gov/qual/nhsurvey11
Feinberg, Lynn, et al. (July 2011). Valuing the invaluable: 2011 update: The growing contributions and costs of family caregiving. AARP.
Abstract:
This report highlights the U.S.'s 42.1 million unpaid family caregivers, who accounted for an estimated $450 billion in value in 2009, up from $375 billion in 2007. The authors outline the toll that unpaid caregiving takes on one's wages, health benefits, savings, and physical and emotional health. The report advocates a significant investment of resources into these caregivers, and concludes with a list of policy recommendations intended to develop a better support system for them.
Obtain the Full Version
Available on the web:
assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf
(September 2011). Raising expectations: A state scorecard on long-term services and supports for older adults, people with physical disabilities, and family caregivers. AARP, Commonwealth Fund, SCAN Foundation.
Abstract:
This report measures and ranks each state's long-term services and supports (LTSS) system for elders and people with disabilities. Minnesota, Washington State, and Oregon ranked highest, while West Virginia, Alabama, and Mississippi had the poorest LTSS performances. The states' LTSS systems were evaluated based on their affordability and access, number of choices of settings and providers, support given to family caregivers, and overall quality of life and quality of care for consumers.
Obtain the Full Version
Available on the web:
www.longtermscorecard.org
(March 2012). Assisted living state regulatory review 2012. National Center for Assisted Living.
Abstract:
This report summarizes the state laws and regulations that govern assisted living facilities, including requirements for staff criminal background checks and age minimums, CPR training, staff-to-resident ratios, and training requirements. It also provides contact information for each state's assisted living regulatory agency and offers brief commentary about regulations and legislation currently under consideration.
Obtain the Full Version
Available on the web:
www.ahcancal.org/ncal/resources/Documents/Final%2012%20Reg%20Review.pdf
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