Like freight trains heading in opposite directions on the same track, two giant forces in the United States are positioned for a head-on collision: the shortage of direct care and healthcare workers and the growing population of older adults who rely upon them for medical care, community services and support.
Without an all-out, public-private effort to create and implement innovative solutions that reimagine and disrupt traditional professional silos and ensure continuity of care, workforce shortages will have a devasting impact on a generation of people who both need and deserve better.
I’ve seen the impending catastrophe in my own family. My parents, who live in a rural Missouri farming town without access to good healthcare, called 911 twice in the past three years. Both times the dispatcher said they wouldn’t come, suggesting instead that my mom load my dad in the car herself and take him more than 75 miles to the closest hospital.
I have not been able to find a single home healthcare provider in their community who will visit them on a regular basis. I can only imagine how a medical crisis would affect someone without an able spouse, transportation or the financial means required to manage an emergency. My parents’ next hurdle will be finding dialysis for my dad in a town without a dialysis center and where the wait time for home dialysis support is two years.
How Bad Is the Shortage?
The healthcare workforce shortage, particularly of nurses and physicians, has been brewing for years but accelerated during the COVID-19 pandemic when burnout hit an all-time high. A Kaiser Health Foundation survey found that nearly 30% of healthcare workers are considering leaving their profession; in 2021 alone, 117,000 physicians left the workforce. By 2026, the American Hospital Association predicts a shortage of 3.2 million healthcare workers.
‘I have not been able to find a single home healthcare provider in their community who will visit them on a regular basis.’
This comes as the population of people ages 65 and older is projected by 2040 to reach nearly 80.8 million; the fastest growing segment of this group are those older than age 85—the people who rely the most upon healthcare and community-based services. All of this is occurring at a time when rates of obesity, Alzheimer’s disease and other chronic health conditions that require regular care are surging in the United States.
The direct care workforce is similarly impacted. The demanding work and shockingly low wages mean fewer employees to deliver critical home- and community-based services for older adults. The Administration for Community Living reports that more than three-quarters of service providers are not accepting new clients, and more than half have cut services because of the shortage. The 44% average turnover rate for direct care workers means disruptions in service and inconsistent care.
Workforce shortages are coupled with too few structured care facilities like nursing homes, skilled nursing and assisted living facilities to meet the demand. Even when spots do open, many middle and low-income Americans can’t afford them. Too many older people who have spent down their retirement reserves are living at or below the poverty level, relying upon family caregivers to survive or ending up homeless. And despite years of advocacy, Medicare still won’t fund adult day services, which can be a lifeline for older adults of all means, meeting social, nutritional, recreational and other needs.
What Are the Solutions?
Fortunately, if we think big and plan creatively and collaboratively, we can slow those trains, get them on the right track, and avoid catastrophe. Solving the impending crisis will require building and empowering the workforce and connecting disparate systems of care to ensure continuity for older adults in meeting their daily and evolving needs. Every solution will require collaboration and investments by federal, state and local governments, as well as private industry and the nonprofit sector.
While it will take time to bolster and rebuild the supply of nurses and physicians, allowing other types of providers like physician associates/assistants (PAs) to practice to the full extent of their education, training and experience would expand access to care almost immediately, especially in rural and underserved communities.
‘Medical visits via phone or video aren’t always appropriate, but they are exponentially more effective than no care at all.’
Unlike other healthcare jobs, the PA profession is growing: By 2031, a 27.6% increase is projected. But outdated and inflexible state laws that do not permit PAs to practice without physician supervision mean that many communities may go without healthcare altogether, or that essential medical care wait times will be untenable.
Laws that prevent care delivery across state lines via telehealth also need to change. Of course, medical visits via phone or video aren’t always appropriate, but they are exponentially more effective than no care at all. Public and private enterprise can work together to expand broadband access to every corner of the country and enable these telehealth options.
Federal policymakers must find ways to incent states to unlock the handcuffs from their capable non-physician workforce to step in where and when they’re needed. Lawmakers have a tremendous opportunity to build the connective tissue between federal, state and local healthcare policy to better meet the needs of every community member, regardless of their ZIP code. When every healthcare team member is valued and respected for their unique contributions to high-quality patient outcomes, everyone benefits.
Equally important is for healthcare and direct care providers to acknowledge that they can’t work in silos; they need to provide care side by side to understand and respect the value each team member brings to the continuum of care. Connecting the dots between each caregiver profession can build the medical care and community resources infrastructure to meet the growing demand. PAs, for example, have a key role to play when they discharge patients back home or into community care or other services. Collaboration and communication are essential for true continuity of care.
We’ve known for years that our dwindling healthcare and direct care workforces will not withstand the surging demand for services as our population ages. Nothing short of a multipronged, national approach with all hands on deck will suffice to head off an otherwise inevitable collision.
Lisa Gables chairs the American Society on Aging Board of Directors and is CEO of the American Academy of Physician Associates.
Photo credit: Shutterstock/Andrii Yalanskyi
