About this Series

This Spotlight is part of the AARP
Public Policy Institute’s LTSS Choices
initiative. This initiative includes
aseries of reports, blogs, videos,
podcasts, and virtual convenings that
seeks to spark ideas for immediate,
intermediate, and long-term options
for transforming long-term services
and supports (LTSS). We will explore a
growing list of innovative models and
evidence-based solutions—at both the
national and international levels—to
achieve system-wide LTSS reform.

We recognize the importance of
collaborating and partnering with
others across the array of sectors,
disciplines, and diverse populations
to truly transform and modernize

the LTSS system. We invite new ideas
and look forward to opportunities for
collaboration.

For all questions and inquiries,
please contact Susan

at LTSSChoices@aarp.org.

Introduction

The COVID-19 pandemic exacerbated an already challenging
environment for finding and maintaining a strong workforce of
paid staff who deliver long-term services and supports (LTSS).
This critical workforce, which includes nurses, personal care
aides, home health aides, and nursing assistants, is essential
to meeting the daily caregiving needs of those who require
LTSS—people who also receive a great deal of support from
family caregivers. Due to the poor conditions and significant
pressures of the jobs, LTSS employees were already under
considerable stress before the pandemic—and the situation

has only worsened with it. Among the persistent challenges to
LTSS workers are physical and mental health risks, poor wages
and benefits, and inadequate training for the complexities

of the care these individuals give to people with disabilities—
primarily older adults.’

This Spotlight describes the LTSS workforce in the Organization
for Economic Cooperation and Development (OECD),? of which
the United States is a member country. After an overview of

Here the term L7SS workers includes nurses and direct care workers. When we discuss a subset of workers, we identify
them more specifically. For example, we have a special section on home care workers in the United States.

2Formed in 1961 to stimulate economic progress and world trade, the OECD is an intergovernmental organization of

37 member countries whose goal is to shape policies that foster prosperity, equality, opportunity, and well-being for all.
To do so, OECD establishes evidence-based international standards and finds solutions to a range of social, economic,
and environmental challenges by providing data and analysis, exchange of experiences, best-practice sharing, and
advice on public policies and international standards-setting. Generally, OECD members are high-income economies.

 

1|

© 2021 ALL RIGHTS RESERVED |
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

the challenges LTSS workers face, we
summarize experts’ recommendations for
reform and describe how some OECD member
countries are innovating to improve the
situation for their LTSS workforce. Finally, this
Spotlight addresses what the United States

can learn from other countries and offers
additional information on the needs of LTSS
workers who serve older people.

The LTSS Workforce

Across OECD countries, 90 percent of LTSS
workers are women, and most of those women
are middle aged. Twenty percent of these
workers are foreign born, and 70 percent
provide personal care with few qualifications.
Fifty-six percent work in institutions,

and 46 percent in a person’s home.? Only

30 percent of LTSS workers are nurses; the
remaining 70 percent are mainly direct-care
workers. They have many different job titles,
such as personal care aides, home health
aides, and nursing assistants.

 

LTSS jobs generally have poor pay and few benefits. Pay in the LTSS sector is 35 percent lower than pay
in hospitals.* Forty-five percent of LTSS jobs are part time, twice as high as the percentage of part-time
jobs in the general workforce in OECD countries. Twenty percent of LTSS workers are employed under
temporary contracts, compared with only 10 percent of hospital workers. Half of LTSS workers perform
shift work, which is unpredictable.*

LTSS workers perform many health-related tasks for which they often receive little training.* Major
gaps exist between clients’ or residents’ complicated needs and the training most workers receive—this
has only intensified with LTSS facilities providing care that was once confined to hospitals.” The most
common gaps in LTSS workers’ skills relate to knowledge of geriatric care, safe management of clients’
or residents’ needs, care following discharge from a hospital, stress and crisis management, methods of
coping with bereavement, prevention of disability, and use of new technologies.® In addition, LTSS staff
often lack appropriate training in infection control.°

PC

3 Organization for Economic Cooperation and Development, Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies (Paris: OECD, 2020).
‘Ibid.

5QECD, Who Cares?

5OECD, Who Cares?

7K, de Bienassis, A. Llena-Nozal, and N. S. Klazinga, Long-Term Care: Valuing Safety for the Long Haul, pt. 3 of The Economics of Patient Safety (Paris: OECD, 2020).

8 Ibid.

°D, O'Neill et al., “COVID-19 Highlights the Need for Universal Adoption of Standards of Medical Care for Physicians in Nursing Homes in Europe,” European Geriatric Medicine 11, no. 4 (2020): 645-50.

 

2 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

Risks to LTSS Workers’ Physical and Mental Health

Not only do LTSS workers typically have poor-quality jobs, these employees also face substantial
physical and mental health risks. Sixty-four percent of workers in OECD countries encounter physical
risks, such as back problems due to lifting people who cannot move on their own, and work irregular
hours or at night.’° Disruptions in shift work can be damaging to these workers’ health and working at
night can result in sleep disruptions that have a broad range of health effects. Forty-six percent of LTSS
workers deal with mental health risks, such as stress and harassment. Workers report high levels of
stress from their care responsibilities, insufficient numbers of staff, and the need to work extra shifts."

In 2016, injury rates for direct service workers (DSWs) in the United States were very high in comparison
with those for workers overall.2 The overall injury rate across all occupations was 100 per 10,000.
Nursing assistants experienced injuries at a rate of 337 per 10,000, The rates for personal care aides

was 144 per 10,000 and 116 per 10,000 for home health aides. Injuries to LTSS workers most commonly
resulted from overexertion, from lifting and repositioning their clients, and violence inflicted by other
people or animals.

LTSS workers are subject to other risks. One is exhaustion from severe time constraints and
understaffing." These employees are under pressure to care for many people quickly. Many clients and
residents often have cognitive impairment or dementia, which can result in harassment of and injuries
to workers. Workers are exposed not only to the same infections that afflict their clients and residents
but also to hazardous drugs and chemicals.

The COVID-19 pandemic has amplified these stressors. A literature review on the psychological impact
of pandemics on LTSS staff found the following:

Mi Fears and concerns about outbreaks (particularly risk of infection), how to manage people with dementia, infection
control, and job loss due to infection

Mi Tension among colleagues

MI Stress due to increased workload and enhanced cleaning protocols

Hi Confusion about job responsibilities

Bi Ethical dilemmas over isolating residents and needing to maintain physical distance from them

BB Work refusal

BB Need for isolation units within facilities for infected residents

MB Workers’ concerns being ignored

HB Lack of information and education about how to handle work challenge

In addition to other job-related stressors, the COVID-19 pandemic makes LTSS workers fearful
of becoming ill and transmitting the virus to family and friends.” Workers may refuse to expose

OECD, Who Cares?

“de Bienassis et al., Long-Term Care.

2§, Campbell, Workplace Injuries and the Direct Care Workforce (New York City: PHI, 2018).

4 OECD, Who Cares?

+Q’Neill et al., “COVID-19 Highlights”

de Bienassis et al., Long-Term Care.

16P. Embregts, W. van Oorsouw, and S. Nijs, “Impact of Infection Outbreak on Long-Term Care Staff: A Rapid Review on Psychological Well-Being,’ Journal of Long-Term Care (2020): 70-79.

Cox, R. H., Dickson, D., & Marier, P. (2021). Resistance, Innovation, and Improvisation: Comparing the Responses of Nursing Home Workers to the COVID-19 Pandemic in Canada and the United
States. Journal of Comparative Policy Analysis: Research and Practice, 23(1), 41-50.

 

3 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

themselves to hazardous conditions, finding that the low pay is not worth the risk they and their
families must bear.

Combined, these stressors put LTSS workers at risk of anxiety; insomnia; stress; and feelings of
helplessness, isolation, and guilt."* Workers in nursing facilities have also experienced trauma during
the pandemic. These feelings may affect their ability to function at work and at home. They may not
go to work or provide inadequate care when they do. Workers may need mental health services to help
mitigate the effects of the stress they endure.

Due to these problems and others, tenure in LTSS jobs is two years less compared with that of other
jobs overall.° Because the LTSS sector has fewer promotion opportunities than does the hospital sector,
many LTSS workers often leave to work in hospitals. Two-thirds of OECD countries identify LTSS worker
retention as a major policy challenge.

LTSS Worker Shortages

Ensuring sufficient staff is critical. Nursing facilities with higher staffing levels were associated with
fewer COVID-19 cases or deaths, according to a review of 30 studies related to COVID-19 deaths in long-
term care facilities. This relationship between adequate staffing and lower mortality is particularly
important in containing cases and deaths once the virus has entered a facility. Additionally, higher
hours of registered nurse staffing are associated with a higher probability of having at least one
COVID-19 case, but with a lower probability of having an outbreak in the facility, according to an
analysis of national COVID-19 data from the United States Centers for Medicare & Medicaid Services
(CMS).”°

Given the aforementioned poor job quality and high levels of risk, a sufficient supply of trained LTSS
workers is difficult to maintain.” And this problem will continue: Between 2017 and 2050, adults ages
80 and over will increase from 4.6 percent to 10.1 percent of the population in OECD countries. People
in this age group are more likely to have complex conditions and dementia, and those health concerns
require LTSS. In 75 percent of OECD countries, the growth in the older population exceeds that of the
LTSS workforce.”? Even with optimistic assumptions about increased productivity, the OECD countries
would have to boost the number of LTSS workers by 30 percent by 2040 to maintain the current ratio of
LTSS workers to older adults.

Across OECD, a sufficient and adequately trained workforce is one of the major challenges for the LTSS
infrastructure.”

Innovations to Address the Challenges LTSS Workers Face

Innovations to address the critical LTSS workforce issues are focused on staffing levels, pay and
benefits, training, and mental health supports. The problems are not unique to a particular country,
and many OECD countries are seeking improvements. Some innovations are government led, while
others are prompted by service providers or medical groups.

48K, M. Knowles, “Global Mental Health Policy Response during COVID-19: Support for Care Workers,” Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, June 7, 2020.
OECD, Who Cares?

2R. J. Gorges and R. T. Konetzka, “Staffing Levels and COVID-19 Cases and Outbreaks in US Nursing Homes, Journal of the American Geriatrics Society 68, no. 11 (2020): 2462-66.

21 de Bienassis et al., Long-Term Care.

2 OECD, Who Cares?

3 de Bienassis et al. Long-Term Care.

 

4 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

 

The Case of Home Care Workers in the United States

In the United States, as in many other OECD countries, governments have moved toward focusing the LTSS
infrastructure on serving more people in their homes and communities rather than in institutions.

Personal care aides assist with daily activities, and home health aides provide short-term care to manage a medical
condition or rehabilitation under supervision. These workers deliver complex care that involves much physical effort,
which can negatively affect their health. For example, home care workers are prone to exhaustion and pain. Clients
also often have mental health and cognitive conditions that make caregiving difficult. Aides have dangerous jobs; they
endure verbal and physical abuse and physical injuries," and few aides have sick leave or disability pay. Aides have
unstable work schedules, part-time employment, and little opportunity for upward mobility. Though many workers
leave their jobs due to poor supervision, they tend to stay in them when they work consistently with the same clients.

In the United States, about 2 million personal care aides and 800,000 home health aides provide care to people with
serious illnesses or disabilities living in the community." The number of workers in these occupations is projected to
grow by 40 percent between 2016 and 2026.

Challenges to having an ample supply of qualified home health and personal care aides are many." In addition to the
physical and mental health stressors, home care jobs carry stigma because of the nature of the work, earn poor wages,
and have few benefits. In 2017, the average hourly wage for home health and personal care aides was $11.12. Home
health aides typically have only 75 hours of training, though state requirements for personal care aides vary, with some
states not requiring any training at all. The Institute of Medicine called for national training standards for aides in 2008,
but little progress has been made since then."

Retaining aides is challenging; in 2017, the median turnover rate for the home care industry was 67 percent annually.!
High turnover rates have been linked to poor-quality care for clients and increased use of hospitals. Continuity of
personal care aides is linked with improvement in clients’ function.

Council of the European Union, European Institute for Gender Equality, “Research Note: Home-Based Formal Long-Term Care for Adults and Children with Disabilities and Older Persons,”
(Luxembourg: Publications Office of the European Union, February 2020).

' J. Spetz et al., “Home and Community-Based Workforce for Patients with Serious Illness Requires Support to Meet Growing Needs,” Health Affairs 38, no. 6 (2019): 902-19.
Institute of Medicine (US) Committee on the Future Health Care Workforce for Older Americans. Washington (DC): National Academies Press (US); 2008.

Staffing Levels

International efforts to address staffing involve recommendations for staffing levels and creative

efforts to recruit workers. For example, the Canadian Centre for Policy Alternatives** advocates

setting minimum staffing levels. It notes that Canadian LTSS workers are seven times as likely to face
violence on a daily or near daily basis compared with staff in Nordic countries, which, despite having
comparable resident needs, boast much higher staff levels. The Centre also suggests requiring nursing
facilities to have a surge capacity of additional staff during a crisis and offer alternative housing for staff
during a pandemic. The government in Ontario commissioned a study of staffing levels in long-term
care facilities.> That study advocated for increasing staffing to a minimum of four hours of direct care

*P, Armstrong et al., Re-imagining Long-Term Residential Care in the COVID-19 Crisis (Ottawa: Canadian Centre for Policy Alternatives, 2020).

5 Ontario Ministry of Long-Term Care and Long-Term Care Staffing Study Advisory Group, Long-Term Care Staffing Study (Toronto: Ministry of Long-Term Care, June 2020).

 

5 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

per day per resident, and requiring a staffing ratio of one personal support worker (i.e., personal care
aide) per six residents during day and evening shifts to improve resident care.

Germany is innovating in a different manner. There, the government has begun using a skill-mix
determination tool to establish adequate staffing levels in facilities. The tool assesses residents’ needs,
time per person per intervention, and the required qualification of staff.?6 Preliminary results are that
Germany needs substantially more nursing assistants and more nurses to achieve optimal staffing.’

Since 2011, about half of OECD countries have tried to augment recruitment of LTSS workers. The
priority is on providing incentives to enter the workforce, improving the jobs’ image, and recruiting
beyond the usual pool of workers.”® Some examples follow:

Ml Norway’s Men in Health Recruitment Program targets placing unemployed men ages 26 to 55 in the health and LTSS
sectors. The men receive an eight-week training program in health care.”

Mi The United Kingdom has a Men into Care Programme designed to recruit more men into this sector. Data from the
United States and United Kingdom show that men in LTSS work 15 percent more hours than do women (in both
countries). Men are also more likely to work full time than women in both countries.2°

i Japan has sponsored training programs for entrants into the LTSS workforce and increased the number of workers by
320,000, or 20 percent, between 2011 and 2015. These programs target and train middle-aged and older workers who
are reentering the workforce after a long break.!

i England is trying to attract 20,000 people to the LTSS sector via a national recruitment campaign, online training and
job placement, and making certain types of instruction available free of charge.”

The Netherlands instituted a one-week National Healthcare Class to help those without experience in the health
care sector obtain LTSS jobs. Graduates are connected to the country’s online jobs platform.

Wi Spain is recruiting new staff, who receive online training and become part of rapid-response teams.**

i South Korea is enlisting family to register as temporary workers and get paid the same amount as professionals to
care for their family members. Caregivers receive a two-hour virtual training session on safety.»

26QECD, Who Cares?
"de Bienassis et al., Long-Term Care.
28QECD, Who Cares?
29OECD, Who Cares?
* OECD, Who Cares?
31 OECD, Who Cares?

324. Comas-Herrera, E. Ashcroft, and K. Lorenz-Dant, international Examples of Measures to Prevent and Manage COVID-19 Outbreaks in Residential Care and Nursing Home Settings (London:
International Long Term Care Policy Network, May 2020).

33F, Kruse et al., The mpact of COVID-19 on Long-Term Care in the Netherlands: The Second Wave (London: International Long Term Care Policy Network, November 2020).

¥# A. Comas-Herrera and J. L. Fernandez, Summary of international Policy Measures to Limit impact of COVID-19 on People Who Rely on the Long-Term Care} Sector (London: International Long Term
Care Policy Network, March 2020.

Slbid.

 

6 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

Pay and Benefits

Research confirms that higher wages improve recruitment and retention and promote longer tenure
and less turnover.** Numerous groups and researchers argue for long-term changes in pay and benefits
for LTSS workers. One goal is to reduce turnover among LTSS workers by ensuring parity across

the health and LTSS sectors.*” Another aim is to create opportunities for full-time jobs.** Long-term
improvements to benefits are also needed, including paid sick leave, training, and vacation. Without
these types of paid leave, workers must choose between their health and loss of income. Without

paid leave, workers lack access to needed recovery time and respite. Workers’ compensation is not a
sufficient solution, because it only applies to diseases or injuries that are related to the job.

Some countries have given one-time cash bonuses to home care workers; others have increased
minimum wages and provided life insurance and paid time off.*° Although many countries made lump-
sum payments to LTSS workers during the COVID-19 pandemic, these payments do not mitigate the
historical low wages.

Training

In response to the COVID-19 pandemic, the European Geriatric Medicine Society and the American
Geriatric Society addressed training in long-term care facilities by recommending that physicians,
nurses, and direct care workers have competence in geriatric care commensurate with the needs of the
residents they serve.*°#! These competencies ensure appropriate coordination of health and LTSS, and
that older adults receive the complex care they need. Among the key topics for training are dementia,
palliative care, and infection control.

Elsewhere, other countries have redoubled worker training in geriatrics and in coordination and
communication skills.*? The United States and Korea provide job training through telecommunication.*
The Centers for Medicare & Medicaid Services (CMS) provided guidance (but not a requirement) for
states and employers that DSW training should go beyond injury prevention and infection control to
include the principles of person-directed care. CMS commissioned for DSWs a set of core competencies,
nationally validated, that is steeped in the principles of person-directed care. CMS’s goal was to achieve
a coordinated, inclusive, and person-driven system “in which people have choice, control, and access
to a full array of quality services that assure optimal outcomes, such as independence, health and
quality of life.“* These core competencies demonstrate that rather than being “unskilled jobs,” DSWs
providing person-directed care must have sophisticated skills in communicating with and empowering

3§OECD, Who Cares?

3? American Geriatrics Society, “American Geriatrics Society Policy Brief: COVID-19 and Nursing Homes,” Journal of the American Geriatrics Society 68, no. 5 (2020): 908-11; Ontario Ministry for Long-
Term Care and Long-Term Care Staffing Study Advisory Group, Long-Term Care Staffing Study.

38M. C. Breadner and A. Durtschi, An Overview of Union, Government, and Employer Actions Worldwide to Improve Conditions in the Long-Term Care Sector during COVID-19 (London: International
Long Term Care Policy Network, February 2021).

39W. Dawson et al., “Mitigating the Impact of the COVID-19 Outbreak: A Review of International Measures to Support Community-based Care,” (London: International Long Term Care Policy Network,
May 19, 2020).

O'Neill et al., “COVID-19 Highlights.”

4. American Geriatrics Society, “American Geriatrics Society Policy Brief”
# OECD, Who Cares?

OECD, Who Cares?

“Centers for Medicare & Medicaid Services, National Direct Service Worker Resource Center, Final Competency Set, 2014. Available from https://www.medicaid.gov/sites/default/files/2019-12/dsw-

 

7 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

DSW competencies include the following:

10.

11.

12.

Communication. The DSW builds trust and productive relationships with people he or she supports, coworkers,
and others through respectful and clear verbal and written communication.

Person-centered practices. The DSW uses person-centered practices by assisting people to make choices and
plan goals, and provides services to help people achieve their goals.

Evaluation and observation. The DSW closely monitors a person’s physical and emotional health, gathers
information about the person, and communicates observations to guide services.

Crisis prevention and intervention. The DSW identifies risk and behaviors that can lead to a crisis, and uses
effective strategies to prevent or intervene in the crisis in collaboration with others.

Safety. The DSW is attentive to signs of abuse, neglect or exploitation and follows procedures to protect people
from such harm. Workers help people to avoid unsafe situations and uses appropriate procedures to assure
safety during emergency situations.

Professionalism and ethics. The DSW works in a professional and ethical manner, maintaining confidentiality
and respecting individual and family rights.

Empowerment and advocacy. The DSW provides advocacy, empowers and assists individuals to advocate for
what they need.

Health and wellness. The DSW plays a vital role in helping individuals’ to achieve and maintain good physical
and emotional health essential to their well-being.

Community living skills and supports. The DSW helps individuals to manage the personal, financial and
household tasks that are necessary on a day-to-day basis to pursue an independent, community-based lifestyle.

Community inclusion and networking. The DSW helps individuals to be a part of the community through
valued roles and relationships, and assists individuals with major transitions that occur in community life.

Cultural competency. The DSW respects cultural differences, and provides services and supports that fit with an
individual’s preferences.

Education, training, and self-development. The DSW obtains and maintains necessary certifications and seeks
opportunities to improve skills and work practices through further education and training.

their clients or residents, observing their behavior, preventing crises, and promoting independence and
community inclusion, among other skills.

Physical and Mental Health

LTSS workers have physically and emotionally demanding jobs. The physical demands may be mitigated
to some extent through training in such subjects as proper lifting techniques and good dementia care
practices. Technology may be another useful resource; for example, special equipment may help
workers transfer and reposition people who cannot move easily on their own. Technology can help staff
monitor residents’ health, communicate with doctors, and reduce paperwork.

 

8 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS workers likewise face mental health stressors. Policymakers and employers’ efforts to mitigate
these challenges include the following:***°

fi Offer counseling. Recognize when staff are under stress and connect them to services such as mental health first aid
training and counseling. Arranging telehealth appointments with counselors is one option for using technology to
help workers facing mental health risks.

Ml Address safety concerns. Discuss with workers adverse events that occur and ensure that safety measures are
followed.

i Ensure communication. Provide clear guidance to staff and be available 24 hours a day to help promote effective
communication. In addition, use a common messaging platform for staff.”

i Supply food. Assist staff by providing them with meals and snacks.
i Provide clinical support. Conduct weekly virtual rounds.
Mi Offer respite. Ensure that staff are not overworked and have adequate rest from their jobs.

Several countries provide psychological support to workers and family caregivers. Austria has a
dedicated telephone line and counseling services for workers. Germany offers telephone services to
educate care providers about COVID-19.*° England has a free text-messaging service for health and
social care workers, which includes bereavement services and supports for anxiety and trauma.*°

A Comprehensive Approach: Australia

In early March 2020, Australia committed funding to train what it termed aged care workers in infection
control and increased surveillance. The effort also boosted staffing and provided telehealth for people
ages 70 and older.

Australia’s approach not only included the financial support necessary to address critical LTSS labor
shortages but also put in place other critical benefits for supporting the workforce during a high-stress
time. Workers received COVID-19 retention bonuses to ensure the continuity of the workforce. In July
2020, workers gained access to up to two weeks’ paid pandemic leave. This leave is available to workers
who otherwise are not entitled to paid leave.

Long-term care facilities received additional funds in August 2020 to support enhanced infection
control, through an onsite clinical lead and more staffing. Australia also funded surge staffing and
rapid-response teams to residential and community care settings. A recruitment organization—

45 Knowles, “Global Mental Health.”
45M. |. Lapid et al., “Providing Quality End-of-Life Care to Older People in the Era of COVID-19: Perspectives from Five Countries, international Psychogeriatrics 32, no. 11 (2020): 1345-52.

“Katherine S. McGilton et al, “Uncovering the Devaluation of Nursing Home Staff during COVID-19: Are We Fueling the Next Health Care Crisis?,’ Journal of the American Medical Directors
Association 21, no. 7 (2020): 962-65.

8 |bid.
* Dawson et al., “Mitigating the Impact of the COVID-19 Outbreak.”

5° Comas-Herrera et al., international Examples.

 

9 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
~AARP’

LTSS CHOICES: REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

Recruitment, Consulting and Staffing Association Australia & New Zealand—organized its members to
provide additional surge staffing for some shifts. Australia allowed international students to work more
hours in residential and home care.

Conclusion

A comprehensive approach to bolstering the LTSS workforce during a pandemic involves addressing
staffing, quality of work, fair pay, and training, and preventing or treating the mental and physical
health risks that LTSS workers face. Australia serves as a good example; its approach during the
COVID-19 pandemic could be replicated during future outbreaks, and it could provide guidance for
tackling the current and ongoing challenges facing the LTSS workforce.

The United States could learn from other countries’ experiences in addressing individual aspects of the
LTSS labor shortages and challenges, by taking its own comprehensive approach. Future LTSS Choices
Spotlights will provide more actionable solutions for consideration.

Appendix
Please see more information about the source articles referenced in the appendix.

 

Acknowledgments

The authors express their gratitude to the members of the LTSS Choices team, particularly Carrie
Blakeway Amero.

https://doi.org/10.26419/ppi.00157.001

 

10 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

PIES 30)

AZojouyraL

COTY PAUL S T=) |
PLUM L UEP)

‘D|Wapued e 8ulNp }Je3s JO}
Sulsnoy aaiyeusaye BULAYO
“SISLID e SULINP yye}s }eUOITIppe
Jo} Ayoeded adins e aAey 0}
saiq}9ej Suisunu Suuinbay

‘ajqesedwiod
ade spaau Juapisad ysnouye
epeues Ul UeU} S]aAa] JeIS
Jayziy yonw arey salijunod
ASA *SAIJJUNOD IIPJON Ul
4415 0} paseduwioo siseq Ajlep
Jeau Jo Ajjep e Uo adua|OIA
3924 0} Ajayl] Se SAW!} UaAaS
ade SJayJOM SSI] ue|peued
yey} aj0u Aayl *s]ana}
SUlJJeIS LUINLWIUILU 3UII}8S
pue sjana] Buyjeys Sulseasoul «
:pualWWOda/ SOY NY

*sadem

sulseasou! pue ‘WuawiAojdwa
SUW!}-]]Ny BULaJo ‘saakojdua
dqGnd way} jo jje Buyew Aq
AyI)192} BUO 0} SUaYJOM pa}d14}S9/
sey epeued ul elquunjoD

ysijug ‘s|wapued ay) 8uing

*swojduwis jo uolj1U309a1 pue
]O4]U09 UO!DAJU! UI pauses) aq
PINOYS GT-CIAOD YUM sjuap!|sed
SUIAJas yes Ay]19e4 Sulsunu ]\V

SUIAI] pajsissy
UCR IN PLR SL

Ee TeR a)
pue ase> SWOH

“qo[ au} 0} payejas aq Jsnw
Aan{ul Jo aseasip ay} asnesaq
qualdyyns Jou si Uolyesuadwiod
(SJaYJOM *SSO} ]e}MuUeUYy pue
yyeay 414} Udamjaq asooud
JSNUW SJd¥JOM dAea] Jo adAy
$14} }NOYIM “BulUled} pue
‘anea] yais pled 3ulpnjou!
‘papaau aie s}yauaq pue
sa8eM 0} S}UaWAaAOJGWI! Wa}
S3U07 ‘AW!} JAA0 1099S BY} Ul
Sa3eM MO} dU} }e3!}!W JOU Op
diWapued au} SULINP SiayJOM
SS.111 0} s}uawAed wns dwny

‘os BUIOP JO}

Jal]a4 xe} 393 pynoys saiy]!9e4
*s}lauaq Yyons yDe] Ua}Jo Ady}
asnedaq sasem Ajnoy anlarad
OYM sdayom Apeynoiyed ‘anea]
ypls pue ‘jedipauu ‘Ajiwiey pred
aney 41S SSI] pue yyeay

pe Jeu} SpuatuWOdaI SOY

}esauay

*6T-GIAOD 3ulinp
40}99S 3123 Wa]-3Uu07
34} Ul SUOI}IPUOD
dA01dUI! 0} aPIMp}OM
suoi}2e JaAo|}dwa

pue uawUsaA03
SUOIUN JO MaIAJaAO UY
*(0Z0Z) ‘v ‘1y2syinq

29 “2D ‘Ww “aUpeaig

*SaAI}DUIAYY AD1]0d
4OJ 2.4299 UDIPDUDD ‘NO
‘PMD}}0 “SISIAD 6T-GIAOD

34} Ul aled }eIWUApISaA
UW119}-3U0) Suluisewil-ay
*(0Z0Z) ‘Ff ‘saeyrnays 7g

Su ‘sapumo7 “fr ‘asaluloyD
SH ‘Suos}suLy

%q ‘Suos}sWwuy

*TT6-806 ‘(S)89 ‘A}a120S
S214} D1495 UDIAaUly ay} Jo
JousNor *saWoOH SUIsANN
pue 6T-GIAOD ‘Jel
Ado Aya1905 s211}e1195
uedLawy *(0Z0Z) *A}a1I90S
sozeLa5 uedaWy

PIPE A

 

 

11 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

suase)

"SSI 40 sed

]]2 Ul S4ayJOM aed PauIp

0} JUaM s}uaLUAed snuog
uoluajaJ pue Woddns «

A3ZojouyraL

VToyHU Ey Ey]
PLUCBUILIUN Tv et=) |

*syual}9
payejosi 10} sdiyspuaty
JENA pue szsiA aUOYda}ay
pue ‘sjeaw pasanljap
-9WOY JO} paseaioul
SUIPUNJ JUBLULAAOD «
“Saale
dnoou3 payeulwlja salsuase

Auew pue Ajjeiiul a1e9 awoY

4194} payaoued sjualja Aue «

Ho

SW} puke S}Jauaq Pasu JJeIS
00} UBISap

2129 U! PaA|OAU! aq pynoys
Kau} pue Aloyepuew aq pynoys
suluuejd ul uonedioiqued
JJBYL *SISUD BY} 10} SuluUe}d
UI PAAJOAUI! JOU a1aM JyeIS SSL]
‘adoung

uJaysey WO} SIapIAOsd aued
JO} paau e pue }Je}s Sulsinu
Jo adeyous e panjonul

SISIID 2429 6T-GIAOD PY4L

Serer SL )7
oT RS to R-LVU Co)

‘}eIS e1X9 BY) paljddns
Ajasie] sajued Woo a}eALd

*aWOY a4ed e U! SiNd90 yea1qyno

ue uayM Yoddns s8uljje}s
adins pue swea} asuodsal
Pides sed yeay payeai5

SUIAI] pajsissy
CRY PLR LIES LL

*sKep yT 410} 332] 0SI-})as

0} paau suayJOm JI JuaWAed
wins dun] e SsiayJOM anes,
“yes 10} SyBaM OM}

Jo area] D1Wapued pasinbay
*sal]Wuey

pue sjuapisad Uaamjaq S}ISIA
pue uoljediunwiwod pue
*Buljjeys paseasoul ‘JOU
Uo!}Dajul UO asn ysnw Aa}
syuawied yioddns pue

dd 0} ssaoje AyWolid aney
SJapIAOId aed pase arey «
solwapued ay} 8ulinp sdays

Jo Jaquunu e yoo} eljesjsny

 

‘ajdoad yim suoldeJ93Uul

0} ANp sduajOIA pue ajdoad
suluol}sod-aJ pue Suly!}
UBNOIYY ‘UO|PaXaJBAO JAYIOM
WOJj pa}}nsad salinful UOWWWWOD
JSOW AY] “SJayxJOM QOO‘OT Jad
OOT SEM SayJOM JO} 2324 Aunful
]]e49A0 aU *syUeRSIsse Bulsunu
40} LEE pue Saple Yyeoy

SDWOY JO} OTT a4aM saunsy

aY1 000‘OT Jed prT Jo aje1 e

ye saunful paduaiadxa sapie
129 JEUOSIAd *]]2JBAO SIAYIOM
JO} $9721 0} UOSLJedWOD Ul

usiy Asan 848M °S’f) BY} Ul
SJBYIOM SdIAJAS JD2J1P 0OO‘OT
dad sayes Ainfur ‘9T0Z u|

yesauay

*y4OM}AEN AdIjod aie
Wal 3u07 j}eUuo}eUsd}U]
Seleaysny ul uonenzs
6T-GIAOD 8425 Wal

3u07 ay (0707 4240390)
*-7 ‘mo7 “*s ‘yomsayiey)

“IHd

9d10J 410M 12D 1941 BY}
pue saiin{fuy a2e}dy10m
(8T0Z) “s ‘eqdwes

*a10W19M0d
*a1e> ‘pueyiez}IMs pue
‘ueuiiay ‘eljsny wol
SISI1D B42) BY} UO Jadeg
UOI}ISO”d Y ‘EUOIOD Jaye
aie) Sulusisapay jawiL
dr uea}> (0702 “snsny)
© Yd1aM “_ “uassalyL
“WN ‘ysiaay “4 S4N7

Sey SyAzoune 6D SayzeD

3 “ayosiayy “WwW “euyoNAg

Ey PYP ELA

 

 

12 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

*Ayayes uo
uolssas SululeJ}
JENpIA snoy Z

e jas SuaseD
“Ajiwey 10} a1e9
0} sjeuolssajyoid
se yunowe awes
au} pled ya3

pue siayJOM
Asesodwiay se
493s 07 Aj1wey
SulINI2—a/ SI
eaJoy YyNOS

PIES 30)

‘uolssaidap

JO angi}e} }e}UaW
adualadxa Aew SuayJOM
pue Ua]OIA aq UaAa JO
sJayJOM ssesey Aew s}Ua!]5
“Bulsua}}eyd ased SulpiAoid
aye }eY} SUO!|PUOd
AAI}UZOD pue UJeey
]e}UaW aney UAalo $}UAa!]D
‘ued

pue uolsneyxa 0} auojd ae
Kau} ‘a}dwiexa 104 ‘y]e2ay4
Jay aye Ajaniesau ued
YdIYM “VoJJa }ed1ISAyd yYonw
SAA]OAU! JEU} 4129 XB]dWOD
APIAOId SJaYJOM JED BWOH

"adIEUD JO da}
aygepene ae ayedIJ 11195
ade BY} 4O SHed °
*quaware|d
qof pue 3ulules} auljuo °
usiedwes
Juawyinioad }euoljeU e «
SIA 1099S
SSL 24} 0} a]doad 000‘0Z
yoeme 0} Bul} s| puejsuy

AZojouyraL

TTeyRU Tey]
PLU ULUON TPES}

ES rTeR i)
pue ase> SWOH

“BWOY BuO Je BUIYJOM 0}
SJaYJOM pa}o1J}SAJ Jaess] pue
epeued Sulpnjoul ‘saujunoD «+

SUIAI] pajsissy
UCR IN PLR LSU

“yeaq JSNW Sal]! Wey 194}

pue Aay} ys ay} YOM Jou

st Aed mo} 4124} yey} puly Aew
SJa4JOM ‘SUO!}!PUOD SNopiezey
0} SaA|eSWay} Bsodxa 0}
asnjas Aew suayJoM ‘Spualiy
pue Aj!LWej 02 aseasip Siu}
SulyIwsues} pue }]! Sulwo.aq
Jo ssaujs }euO!ppe ayy
SJaYJOM SSL] S8ULIg JIWapued
6T-GIAQOD 24} ‘Suossaiys
SUIJNOI J9Y}O 0} UO!TIPpe UI

“ewuned}

pue Ajaixue 10} sjioddns pue
Sed1|MJas JUBWAaAeaJaq Sapn)}oul
UDIYM ‘SJayJOM aJed ]eID0S pue
yqeay 0} ad|AJas Bulsessaw
7X9} 8a} e SUIPIAOId si puejsuy

“suuea}
asuodsa-pide jo ped awosaq
pue Sujuses} auljuo anjadas OUM

Jes Mau BulNi9ad S| uleds

}esauay

*OT-T ‘e21}9e1d

pue ydjeasay :sisAjeuy
Add aAijesedwios jo
Jeusnor *sa}e}S paziun
dy} pue epeues ul
DIWASPULd 6T-GIAOD 24} 0}
S1a41O/M SWOH SUISANN jo
sasuodsay ay} Suluedwo>
suonesiAosdwy pue
Suol}eAoUU] ‘adUe}SISaY
*(TZ0Z) ‘d SeeW 7g

“q ‘uosypId ou " ‘x09

 

suosied
Jap]o pue saijniqesip yyIM
uaJp}iy> pue s}npe 4104

31D Wd}-3U0] JULIO}
paseq-awioy :a}0N
youeasay (0707 Asenigqa4)
‘Ayenby sapuay 103
d}N}1}su] Ueado.ng ‘uoIUy
ueadojng dy} Jo }I2uN0>

*y4OM ON AdI]0q B1eD
Wal 3u07 }euo}}eUs9}U]
*S3UI}}2S BWOH SUISINN
pue aie jel}Uapisay

Ul S¥23143NO 6T-GIAOD
aseuew pue wUahald 0}
sainseay jo sajduiexy
yeuoljeusazu] °(0707 Aew)
*y ‘ueqg-zuUd107

793 Youoysy “Vy
*e1a119}H-SPWIOD

*yAOM JAN AdI]Od aed WAL
3u07 }euo!}euU419}U] 10739
die) W4a,-3U07 ay} UO Aja
oyM a}doad uo 6TAGIAOD JO
peduil PW 0} seunseaw
Adijod jeuol}eusa3Ul Jo
Asewiuuns *(0707 yo4eW)

“1 'f ‘zapueusas 9

Sy Sela1aH-Sewo;

PIPE A

 

 

13 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

“Suluses}

Jo sinoy om}
Jaye SuayJOM se
Aed awes au}
aAlada4 Ady} pue
ssaquuaw Ajiwey
syinioad ea10y
yynos ‘ssase9
pied aq 0} Ajiwey
pue siaayUnjoA
yn49a pynoys
qUBWUJaA0D
*‘papaau

ase Adu} aJayM
$J99}UN]JOA AJIP
0} weisoid
Jeuoijeu e

sey puejal|

PIES 30)

AZojouyraL [Coy pNUE HTD y|
LUCE L RPL) el

*6T-GIAOD yNoge suapiAosd
ade) ayeINpa 0} Sad1|AJas
auoudayay suayjo Auewuay
*SJYJOM UBI9J04 0} YDeaJ}NO
pue S1ayxJOM JO} Sdd1AJaS
suljasunod pue aul] auoUda}a}
pajzesipap e sey euysny
*syased Ajlwey pue SiayJOM

0} Woddns jes130j0y>Asd
aplAoid saljuno;

*yIOM

youued jyeys JI Jo aww} pled
pue aduesnsu! a4!) papiAosd
pue ‘sasem wnuwulWw
paseaidul ‘suayJOM aed aWOY
0} Sasnuog ysed alw!}-au0
papiaoid aney saljunoz

«SJOPIAOId ad1AJas ]eUassa,,
SJaYJOM a1ed BOY Waap “S‘/)
dy} BUIpNjouI ‘saliyUNOd aWOS

*S1aYJOM a1ed
awWoy }euoNIppe payns9a,
BARY SAILIJUNOD ]e1aAVS

ES rTeR i)
pue ase> SWOH

SUIAI] pajsissy

}esauay

*0Z07 ‘6T

Aew ‘y40M aN Ad1]0d a1eD
Wal 3u07 }euo!}euU19}U]
‘42D paseq-ApiunWWOD
yoddhns 0} sainseay
]eu0!}eU19}U] Jo MalAaY
4221q2NO 6T-GIAOD 243
jo peduwy ay} Sunesniw
*y ‘e1d119H-SEWIOD 7g

Sy ueg-zuUal07 “3
‘youdysy “mM ‘uosmeq

PIPE A

 

 

14 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

PIES 30)

9D1JJO ]E4JUDD © YPM
SU!JEUIPIOOD a}IYM auo]e YOM
Ua]O S194JOM aJed aWOY ‘Os}y¥
*SUA}IP JUBLWUOJIAUa BOY
yoea pue ‘aed SulJaaljap ale
OUM SJaAIsaIe9 AjLWe} UM
3}EUIPJOOD JSNW SuayYJOM
‘saoy Jay} ul AWouojNe
aAey S}Ual]D yey} ade AayL
SS. Ajenb 3uunsua 0}
sa8ua}jeud juasaid aseo

awoy Jo s}dadse }esanas

ES rTeR i)
pue ase> SWOH

AZojouyraL

COTY PAUL S T=) |
PLUM L UEP)

*sasunu

aJOW aWOS pue BUlyye}S
Jewydo analyse 0} s}ue}sisse
sulsinu ajow Ajjenuejsqns
spaau Aueway yey} ae
sqnsau Aeulwuijajd ‘papaau
Jeys JO suolyeriytjenb ayy

pue ‘Suo!UaAJa}U! ASO} 104
uosiad Jad pasinbas awl} ay}
‘paau S]Uap!sad SUOIUAAJAzU!
JO XILW a4} JUNODIE OJU! aye}
]]!M 100} ay “yeU} ISN{ Op 07
]00} e Buldojanap si Auewuay
Ul UalUaig Jo AjISIBAIUA) ABUL
“YNIYJIP SI SAIIOey sed Way
-8UO}] U! SJAYJOM JO XILU }]I4S
ayetdosdde au} B8ululwuajaq
*sjuapisel

JO Spaau jed1paw ay} Jaa 0}
Asessadau SI 8ulules} 4184} pue
$]aAa] Sulyeys Jo uolejnsay
*sjeyidsoy

0} paulyuod aq 0} pasn jeu}
aded apiaodd sae} Auew
‘a}dwexa 104 “aAlaa1 SJayJOM
sow Sujules} ay} pue spaau
pajzesijdwod .sjuapisai 10
qual] uaamjaq s}sixa des
Jofew e pue saseyoys Jay0M
aduUaladxa salujunod Auep »
-40}2aS

SS au} 404 Sasuayjeys sofew
BU} JO BUO S| 9DJOJYJOM paulel}
Ajayenbape pue quaisijns y

 

SUIAI] pajsissy
UCR PLR LS

*aseasoul A}UO

]1IM sJayJ0M paulei} jo Ajddns
qualoyyns e Bululeyu/ew Ul
sasua]]eup ‘os ‘eljuaap pue
SUOI!}|PUOD Xa]}dWOD aney 0}
Ajay] BOW ase dnois ase siyy
Ul a]doaq *sals}UNOD GDqO U!
juadsad TOT 0} Juadad o°7
WO4J ASBAJDU! ]]I/M JaAO pue
08 a8e sznpe jo uolodoid
24} ‘0S07 pue LTOZ Uaamjeg
*sqol

snoledaid pue ‘sasem Mo}
‘Sa]NWWOD BUC] ade} S1ayJOM
“syeoiwayo

pue s8nip snopuezey se }jam
se aney sjuapisad pue sjual]>
ALBY} JEYY SUOHIAjU! BY} OF
pasodxa osje ase siayoM
*yJOM YIYs pue ‘Buljyeys-HOUs
se }]am se ‘saiiiqisuodsai
2429 Ja} 0} aNp ssajs Jo
$]2A9] Y8Iy Woda SsIayJOM
“eluawap

JO JUaWUJedWI! aAI}}U3OD aAey
uaqjo pue ‘spaau jeaiskyd
pue jeo1paw xajdwos

aney SjUapisad pue s}ual]d
asnesaq sqof Sulpuewap
Ayje2!80}0ysAsd pue
Ayjea1skyd aney $iay¥J0M SSI
*$9130]0UYI9} Mau Jo asn

pue ‘Ayigesip yo uoljuanadd
‘juawaneasag YM Buldoo

JO spoyjow “uawaseuew
SISIJD pue ssaujs ‘JeyIdsoy
WO4JJ ASJEYISIP SUIMO}]}O}
aJe9 ‘spaau ,s}Uap!sas JO
squal]9 JO Juawaseuew

ayes ‘a9 D1}e11938 Jo
a3pa}Mouy 0} pajejai ase
SIMS S1941OM SSI] Ul!

sde8 UoWWOD JsOwW ay] «

}esauay

d930 ‘ney Buo]

dy} 10) Ajayes Suinjep :21e9
W413}-3U07 311] ed Ajayes
jualj}ed Jo sd1W0U0da aUL
*(0Z0Z) *S °N ‘eSuIze]y

23 “yy “JeZON-eU2)}7

y ‘sisseuaig ap

PIPE A

 

 

15 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

IES to)

AgojouyraL

Toye yy]
PLU ULUNTIP ELS

Senter 9) 4
joLeL-R- 3] to RLF eCe) |

“Ayoey ayy ul yeasqyno

ue BulAey jo Ayijiqeqoud

JAMO] & YIM yng ‘ased auo
ysea} 3e BulAey Jo Ayiqeqoid
Jaysiy e YyyM payelsosse aie
SUJe}S aSINU Paaysi3al Jo
sinoy Jaysiy yey} pamous
syjeap pue sase> 6T-dIAOD uo
0z0z eunr Aq ajgejiene ejep
SWND JeuUo!}eU Jo sisAjeue uy

*SUO!]USAJA}UI!

uO ajqeyiene saipnys ON

*yIOM

Jay} Noge yay Aay} sayeq
au} ‘mauy Aay} asowW ay
*sa8ua}]e4yd YOM 4194} a]pueYy
0} Moy jnoge uo!}ednpa

pue uonewojul Jo ye]
*pasous! Bulaq SUJa2U0D 4!aU |
*s]uapIsal

paydajul pazejos! 0} $ai}]!9e}
UIUUM SUN UO!e]OSI JO} paan
:payodau yes

‘yesnjas YIoM «

Way] WOJJ 8DUe}SIP

yeoisAyd ulejuew 0} 8ulpaau
pue sjuapisal 3ulje}0sS!

JAAO SPEWWA]IP 1291434
*saluiqisuodsau

qof jnoge uolsnjuoD

“syse} Bujuea}9

paseasoul pue peojyiom
paseasoul 0} anp ssaij}s
*san3ea}]oo 3uowe uolsual
*UO!}DaJU! 0} ANP sso] go pue
‘J04}UOD UO!}DAJUI ‘el]JUaUAp
UUM ajdoad aseuew 0}

MOY ‘UO!}DAJU! JO YSL J19U}
Aysejnoiwed ‘syeaiqyno

ynoge susjadu0d pue sea
:payodai yes

*way} Woddns 0} saunseaw

pue JJ} SS 17 UO Sd|LWapUed Jo
yoedu! jeo!30joysAsd au} jnoge
MAIAAJ 81N}e19}!] & PIp SsIOUINY

BUIAI] pajsissy
URSIN PLR USL

Jesauay

“9907

-@9v7 ‘(TT)89 ‘A}a190$
$31}D1199 ub aUy

94} JO JDUANOL *saWiOY
SUISANU Sf Ul Syeaiq}no
pue sased 6T-dIAOD
pue sjana) Suyeys
*(0Z0Z) “L*u “ex4z}QU0y
73°F *Y ‘sa3105H

*6L-OL ‘0Z0Z ‘asD) ual
-Bu07 Jo jousnor *suiaq
-]]8M 122130) 0y>Asd uo
MalAa. pide e 3yye}s aed
W119}-3U0} Uo yea1q}nNo
UO!}D9j UI JO edu] *(0Z0Z)
*s ‘sfin 72 “MM ‘Mnosi09 UeA
Sq ‘s}Zai1quiq

PIP ELA

 

 

16 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

ESI to)

v=o) (ole Tg

oyna yy]
PLUTON TPES}

Sener)
pue a1e> BWOH

“Sulsnoy aaijeusaye

YUM Way} SulpiAosd pue

aseasip ay} 0} pasodxa jje}s
Ayyloey Bulsunu Buluuesend «

J9U9BO} payzeai}

212 6T-GIAOD YUM Sjuapised
aJaYM ,Sa}qqnq,, BuIjeasD «

‘soley

UaaMjaq S}UBWAAOW ,S1aYJOM
uyyeay pue szISIA SUIIDIISAY «
shq
6T-GIAOD 0} pa}2ea4 asodeBuls

SUIAI] pajysissy
URSIN PLR SLIT

‘syeaug
pue }saJ ajyenbape paau 4421S
“Buljasunod pue “sulules}
ple say yieay jeyUaW
SUIPIAOJd ‘sad1AJas 0} Way}
yauUod pue ssaujs }e}UaW
aAeY JJe}S UBYM 9Z|UBOI9I 0}
paau siaXojdw9 ‘pamo}}oj
ase saunseaw Ajayes Jeu}
suLINsua pue ‘sjuaAa asJaApe
Jaye Buyalqap ‘juaWwUOIIAUa
SUILJOM aAtuoddns e
8ulj}ea9 ‘S1OJaSUNOD YIM
sjuawjulodde yzeayajay
se yons ‘AZ0]0uUIa}
8uISN apnjoul SiayJOM
2429 Wa}-3U0] Jo spaau
yyeay jeyUaw au} Woddns

0} SUO}JEPUaLULWODaY «

*yuawAojdwa

pue AjIAI2Npoid Jo sso} pue
4yeqs Suowe Aypiquow pue
Ayjeyow paseaidul ul }]Nsed
ued Woddns 0} ssaaze Jo yde7
‘ayed ayenbapeul

aPpiAosd Jo Juasqe aq Aew
Aay] ‘awoy je pue y1om ye
uolqoUNY 07 AyIGe say Jaye
Aew s8uljaay asay| *Saiz19e}
sulsinu ul Sedualadxe auljnol
JJay} pue d1Wapued au} 0}

anp ewines aduauadxa osje
Aaul WINS pue ‘uoljejos!
‘ssaussa]djay jo ssuljaay ‘ssais
‘eluWwosul ‘AjaIXUe Jo ySIJ }e ale
SJ94JOM 6T-CIAOD $0 Y]NSaJ e SY

Jesauay

*0z0z oune 2 “3S1-D3dd
*ysomzaN Adio aie
WJaj-3u07 }euo}eUs3}U|
§310°pIAODD 1] Ul ioday
*S1BYAOM 3129 10}
yoddns :6T-dIAOD
Sulinp asuodsa. Adijod
yqeay }e}USW }eqo}5
*(0Z0Z) ‘Wy ‘S2}mouy

‘0707

‘Ane *y4AOM}aN AdI]JO_d a1eD
Wal Su07 }euo!euU1a}U|
*aoualiadxg aiodesuis
SUL 2185 jeIUApIsay Ul
6T-GIAOD 0} Sulpuodsay
fy ‘Suom 3 OM ‘weyeip

PIPE A

 

 

17 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

“weisoid
adueunsu! aed
WJ3}-3U0]
s,AueWwa5
y8noiy3 skep
0Z 0} dn Jo}
aed SulpiAoid
Jo} sjuawuAed
yeyuawajddns
aAlada1 UD
sjased pledun

PIES 30)

AZojouyraL

‘oIapued

34} BULINP SULY4IOM JO}
Way} 0} sjuawiAed snuog
aU/I}-3U0 papiAoid pue
SJa4JOM SSI JO sasem
Ajanoy pasties Auewa

COTY PAUL S T=) |
PLUM L UEP)

ES rTeR i)
pue ase> SWOH

“seaue

S34} JO BuO A]UO UI! ¥0M pjnoys
HIS pul GT-GIAOD YIM eso,
JO} AUO puke ‘sased paydadsns 404
auo ‘swo}dws ynoyym ajdoad
JO} BaJe BUO OU! SUO!}N}ISUI
4!94} @PIAIP P]NoYs sely}lae4

‘ys9J
0} 8]Ge ade Jye}s OS BD10JyIOM
dy} UO spuewap aseuew

0} S| UO}JEpUaWWOIAI Y °
‘olwapued e 8uLNp 3UIyIOM
JO SSaJ}S BY} 0} aNp yoddns

]e2130)0ydAsd paau jyeys SST °

SUIAI] pajsissy
UCR PLR LS

*w04}e]d sqof auljuo

3U} 0} pa}auUOd ale sayenpely
40}9aS S14} UI SO! 383 0} 10}9aS
ase) Yyyeay ay} ul adualJadxa
}NOYIM asSou} djay 0} ,sse]D
auedyeaH Jeuo!eN,, Y2aM-auo
© pa}nzJsu! SpueLaYy}aN ay
*SJay4JOM JO

paau yead3 ul SIap|Aodd asoUy
0} jauUOSJad SSI] pue YyYeaY
yo}eW 0} Woj}e}d auljuO

ue payeasd Spue}JayJaN aU L

}esauay

*yAOM}AN AdIo_ a1eD
Wal 3u07 }euoNeUs9}U|
*UONeN}IS a4eD Wd}
-8U07 6T-GIAOD 243 pue
Auewuay (0707 Aew)

Sy 9queg-zual07

“TSET-SVET

*(I1)ze ‘sou.oUaBoysAsd
Jouo/puUa}U] *Sa14}UuN0>
SAL} WA) SAAI}Iadsiad
*6T-CIAOD JO B1d 94} Ul
a)doad Japjo 0} d.1e2 a4i)
-Jo-pua Az enb Suipinoid
*(0Z0Z) °D ‘yesied 2

‘7 Sy0]g Uap Ue)

6-3 Suosduies

Sy ‘sueudooy “| ‘Ww Spidey

*yAOM aN Ado a1eD
Wal 3u07 }euo!eUsd}U]
“SAP PUOIIS 2Y}
{SPUE}OUION 2Y} Ul a1e>
W13}-3U07 UO 6T-GIAOD
Jo yoeduy] ayL (0707
AaqUianoN) ‘d ‘uaysine
23 °° psvoy Aap ueA

9 ‘uazulA “7

ol uen *4 Sasnay

PIPE A

 

 

18 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

PIES 30)

AZojouyraL

COTY PAUL S T=) |
PLUM L UEP)

ES rTeR i)
pue ase> SWOH

]013U09 UOIDajUI

ul yye}s UleJ} pue ajyeonpa
0} Sasunu padualiadxa asp) +
“yeys asnjuod
sauljaping 8ulsueyp ‘osjy
"Add 383 0} 8]38NJs ]]19s pue
s]ysnoypaye a4aM SJaYJOM SS17
‘sislJd 84) OU! SYJUOLU ‘A]]}Eqo]5
‘soley
9]dI9]NW ye YOM UdYoO JeIS *ydIS
3]!YM ¥JOM 0} s}uawadInbas pue
‘sadem MO} ‘aAea) yIS Aue 4! 8}79!)
‘speo]4iom Aneay “uawAojdwa
awi-Yed ‘saiqyI9ey Sulsinu
UI SuljjeJSdapUN d1UOJYD YUM
3]83NJ}s S19¥JOM SSL ‘Ay]eEqGo]9

SUIAI] pajsissy
UCR PLR LS

*UO!}E]OS! JUSPISAJ SZIWIUI «
‘aueo aanenjed pue a4I)

-JO-pua jo Ayljiqejiene ainsuq «

:pynous sao!}9eJd jed1U!]9 MAN
*Salq!]10e} SUISINU 0} SBUIaS
Jay}O Wo. yeys Aojdapay «
‘Red anea] yas pue psezey
Pue “YOM SWI}-}]NJ J2AYJO »
:7ey} saldijod
sadinosaJ uewNny JUuawWa|du|
*sqof 4194} WoL}
ysaJ aAeY pue payJOMJaAO
},uase yyeys Buunssy «
“spunol
Jenyia Ajyaam Bu oNpuos «
“YeYs 0}
SyDeUS PU S}PAaW BUIPIAOId «
‘yous pue
ssaujs aSeUeW Jye}s SUId]aH «
:Aq Ayyeay yyeys daay
‘YeIS YIM a}ed|UNWIWOD 0}

Wojjejd Sulsessaw e ap|Aold «

Wa} 0} SINOY HZ
a}geyiene aq pue jJe}s 0}

SdUePINS Jea]d aPIAOId «

saue Saljyioey

sulsunu ul 4ye}s Yoddns

pjnod yey} sdays ay} Suowy

*sjeyidsoy wo.

squaijed asieyrsip 0} sadejd se

Ja}72] 8y} BuIMalA AjUO a}1UM
‘salqijloey SUISINU Jo JUaWI}ap
dy} 0} sjeydsoy azi}0ld

0} Sem d|LUapuUed au} 0}

asuodsa, }e!}1U! Sal4jUNOD ISO

}esauay

*G96-Z96 :(0Z07)

‘ou ‘TZ uonDIDossy
$40}2a4Iq ]D2IPaW UDILaWYy
94} JO oUINOL .¢ ZSISIAD
died yyeay xou ay}
Sunjany am aie :6T-GIAOD
SULINp je}s aWOY
Suisinu jo uolenjeaap
dy} SulaAoouN,, ‘}e

2 Medsog anbiuosap
‘zayoues Bad e119S}UOW
‘eSiunz eysizuesy ‘nyd

*H auapeyD ‘uops0yD
wepy ‘}oUld-3119sq pl4asy
§§ aUIAaY}LY ‘UOPINIW

PIPE A

 

 

19 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
*syased
JO} ay1dsaJ 0}
quawa)}jua
$124J0 AURA
‘pledun Jo pied
Jayye ‘aAea]
Ayiuue 104
sulpiaoid Aq
$1219 JO B]OI
aU} az1UZ0Ia1
(0€) Seu}UNOD
dD40 40
sJayenb-aaiy

 

“SHSIA JUaWLedap
Aduasiawa pue
Buljjejs paonpal
aAey WYBIU ye
seaweed pue
sjosuas ‘AEMJON
pue spuepayjen
dy} ul ‘aj}dwexa
404 'S1OJDOP YUM
ayed|UNWWOD pue
‘Buljiig ‘ysomieded
aonpa ‘spiooad
uqeay aja}dwos
‘5]U1]9 JOPUOW
djay ued 313nq
aed jeuosiad
ayewjzu! ade}das
youued AZojouysal
‘ainssaid poojq

Jo aunjyesadwa}

e 3ulye} se yons
‘syse} payejai
-Yqeay J94)

UIIM SJayJOM ased
jeuosiad djay

ued sple jeysiq
‘uoljzed]UNWWOS
-3]8} y8nosuy
sulules gol
dAOJdWI apIAosd
easoy pue ‘Ss’ aul
jueyodw!

Sulaq se syse} aed
Jo uonedo]je sayaq
pue AZo0jouyr92}

Jo asn aas ueder
pue ‘spuepayieNn
24} ‘sal}UNOD
uelAeulpuess
*BUJO}JUOW

Sd9 pue ‘suosuas
‘sauoyd pews

se yons ‘ajduis
ade sal3o0jouyse}
ay ‘salyuNod
DIPJON pue ueder
ul Ajeuid

{4099aS $S.11 ay}
0}U! 3uI08 A]Mojs
s| ABojouyrda)

 

“JBAOUINY SS2]
pue ainua} Jasuo] ayowod
pue ‘uo0!}Ua}9J Ua }INIIe/
aAOIdU SaBeM Jaysiy
yey} Sysixa auaplAy
*SJayIOM
ules} JO y1NIIa/ 0} sjueds
paplaoid aney eluewoYy
pue ‘jaess] “S77 ay
“weisoid Sujules}
2 YUM Way} BuIpIAoJd
Aq yeasg 8uo} e Jaye
30J0JYJOM ay} BULJa}Ua
-d1 12 OUM SJAYJOM
Jap]o pue pase-a}ppiw
sade} wessoid sIuL
“GT0Z pue TTOZ uaamyeq
quadiad 02 10 000‘0zE Aq
SJaYJOM JO JaqUINU au}
paseasduUl Pu Bd0JYIOM
SS. 2U} 0} sjues}Ua
Joy swessoid Sujules}
pasosuods sey ueder
“SN 84} Ul
aJOW Sjulod jysla pue yn
3} Ul UBWOM Ue} dW}
-}]NJ y40M 0} Ajay!] B10
sjulod asejuaciad gt ae
UAW OS}V *SlJ}UNOD Y}OqG
UI UBWOM Ue} SuNoU
SJOW JUIIIAd GT YIOM
SS.7 ul Uaw jeY} MoUs
YN ay} pue Sf ay} wo.
ejeg ‘awWeIZO1d ae)
oq! Ua e Sey YN aYyL
*ayeo yyeay
ul Weigold Bululel} yaOM
-Jy8la ue anladas AayL
*10]D9S SS1] pue yyeay
a} 0} GG-9z pase usu
paXojdwaun pajyasse}
WeIZO1g JUdLUIINIIAY
YedH Ul Ua; SAeMiON
*2DUe}SU! JO} UB
- $J84JOM JO ]oOd jensn
ay} puofag 8uljIn4da4 pue
‘ase! sqof ay} SulAosduu!
‘Q0J0JYJOM BU} 19}Ua 0}
SaAl}UaDU! SUIP|AoJd UO
Ss! Ayoud ‘op Aayy auaym
“TTOZ B9UlS SABYJOM SST]
Jo JUaWAINIDaJ aseaJDUI
0} pal} aAey SalsjUNOD
adg0 Jo sey Aju

 

 

*pauinbau

eqs Jo UOedYHeENb ayy

pue uol}UaAJejU! Jad UosJad

Jad awl} ‘spaau sjuapisel

SaSsasse ]00} au] *SAl}]I9e}

UI S]aAa] Buljje}s a}enbape

USI]Ge3Sa 0} 100} UO!}EUILUJa}ap

XI ]}Iys e Sasn Auewa5

‘J@AOUIN] J84JOM paonpa OF

Pa] YIYM “414s Jo Bd1049 pue

SUI|NPayYs a)qIXa]j 10 Moje

yeu} sawoy Bulsinu ul sjapow
juawaseuew Bulsn si elejsny «

 

*BUUeJ} 8]}}1] Alaa

Aauy YUM JO} ‘syse} paze}ai
-yyeay Auew saajoAul ¥10M
JJ9UL “SASINU JOU B1e BDOJYIOM
SS11 84} Jo JUadIad AyUanaS

*Awouojne a}}}1] pue ‘saunssaid
SWI} Baas aAeY OS]e SJBYIOM
asay] “juawssesey pue

ssaujs se yons ‘sys yyeay
yejUaW aAey JUadJad gy pue
YJOM 4194} YUM payelsosse
‘suia}qoid yDeq se YoNs ‘sys
JeoisXyd ade} saiujun0d GD340
Ul SJAYIOM JO JUdDIAd INOJ-AYXIS
“yyeay 412} spayje Ajaajesau
UDIYUM “YOM YIYS OP SIayIOM
SS11 40 JJEH ‘SuayJ0M jeyIdsoy
Jo JUadJad OT 0} pasedwos
‘sjoeuquoo Ayesodwa} Japun
pahojdua aye siayJ0M Jo
quadiad Ayuamy *sajuNnod
930 u! sqof jo agequadiad ay
se ysiy se adIm} fawi}-Yed ase
sqol SS11 40 Juadiad aAy-Ay04
*sqof se}IWiIs Ul SIayIOM
Jeydsoy 104 pT 0} pasedwos
“noy ue soina 6 adesane UO
used SJayJOM SS 1] SAl}UN0D
ueadong uy ‘sjeyidsou

Ul UU} JAMO} JUaDIAd GE

S| 10}9aS SS] a4} Ul Aeg

“awoy

s,uosiad e ul JUadIad gy pue
SUOI}N}PISU! Ul YJOM S1ayYJOM JO
quadiad xis-Al4 ‘suoiedyijenb
M2} YUM a1ed Jeuosad
aplAojd Juadiad 07 pue ‘uiog
USIa1OJ aie JUadIAd QZ ‘pase
-3]PPiW SOW ‘USLUOM ase
SJBYJOM SSI 40 JuaIAd C6
‘saluJUNOD GIO SSOJDY

*S}/Npe Jap]o 0} siayJOM

JO ofjeJ JUALIN ay} UleEUIEL O}
0v0z Aq quadied o¢ Aq suayiom
JO JaquUNU ay} aseaJDU! 0} aAeY
P]Nom sayUNod GAO au}
‘AWA INposd paseasdul ynoqe
suol}duunsse 31}S1wW3d0 Japuy,
*2D0J YOM SS 17 84} Ul YMOIs
dy} Spaacxa Uol}e]Ndod Japjo
34} Ul YIMOIZ au} ‘sajUNOD
930 JO Juadied GS) U| ‘sJayIOM
paulesy jo Ajddns qualoijjns e
SULINSUA SI WAY} JO 9UO *SS1T
Ul SwWa}qoid jesnjonsjs Sulysixe
Buj}eq189ex9 S! 6T-GIAOD

 

“sulysiqnd
a930 ‘saipnys Aanjod
yyeeH 950 “Ayapa
BY} 10J SAayAOM a1eD

Sululezyay pue Sunoeyy
ésaied OYM (070Z) Gd30

 
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

*S}]IyS UOIVeD!UNWLWOD

pue uoljeulpsood pue
‘solujelas Ul Sulu}
JayJOM paseasaul

BAY SALUJUNOD BWOS
“spaau jual]> yoea

aded Jo JUNOWe pue adh}
34} ap!dap 0} AWouojne
aJow sasunu anis ueder
pue eljeujsny ‘spueyauian
dU} Ul SLU} paSeUeLU-}]aS
*sweisoid

SuUl0}UaW *S*f) ay} pue
‘sadlAsas 3ul]aSuNOd
ueder ‘sweisoid
juawaseuew ssaijs
paznyysul spueyayjan
SUL “JUBLWUOIIAUD YOM
SY} BAI! 0} Pali}

AALY SALI}UNOD ]e1BABS
*sadem Jay} paseasoul
yey} saduemoyje anes easoy
pue ‘GTOZ UI SJayJOM aed
awWoyY 0} adem WINWIU! LW
papuayxe *S‘f aU

CIES I-40) v=o) (ole Tg [Coy LUTH Tp y|

PLUTON TPES}

Sener)
pue a1e> BWOH

“Ayyioe} e pasaqua

sey aseasip ay} adu0 suj}eap pue
sased Bulule}U0d ul JUeYOdUI
Aysejnoiyed si diysuoiejas

SIYL *S2!]!9ej a4} Ul SYeEP

JO S8SCD GT-GIAOD JAMA} UUM
payelsosse am Sana] SULjJe}S
Jaysiy YM saiq9ey SuIsINN

FUN Beef
URSIN PLR USL

*saly}ioey aed
WJ9}-3U0] UI SYJeaP 6T-GIAOD
0} pajeja4 TZ0z Auenuer pue
07Z0Z Judy uaamjeq saipnys
O€ SMaIAad Jag aNssI aU L

“uO!}eUIPsood

aed pue AZojouyra} YsnosU}
SODdIAIJAS JO SSAUAAIJIAYJa BU}
sulseasou! pue ‘Bujujes} pue
Ayyjenb qof Zulueyua ‘pyalj au}
0} SJaYJOM MAU BUI}eINe ale
Kay. *S4ay440M SSL] payienb
Jo adeyoys ay} Bulssauppe

0} saydeoidde aaiy} uaye}
aAey Sl}UNOD GIO

*SS11 40} pasu

s,uosiad e Aejap 0} sa!a1]0d
uolquanaid pue ‘uo!}eUIps009
ade) pue A8o}0uYIa} Jo asn
‘Bulules} pue SUONIPUOD
S8UlyJ0M B8ulAoJdui| sasinbad
8Ua]]}EYD 9dJ0JyJOM ay} Bulde4
*asuayjeyo Aaijod sofew ese
UO|}UA}2J JAYIOM SS17 Apquap!
S2JUNOD GIAO JO SP4IYI-OML
*s]eyIdsoy UI ¥10M 0} aAed]
Ua}JO JAWOJ 24} Ul SIdYJOM
pue 10}9as JeyIdsoy ay} ul UeYy
saiunyoddo uoljowod Jama}
sey 10}99S SS 17 UL *}]}e4aA0
quawAojdwa ul uey} ssa] sueah
OM} Ss! Sqof SS 17 Ul anual

Jesauay

*uoljepunoy

Ajiwel Jasiey “Mmainey
d1nN}e19}17] & Woy SsUuIPUly
$S9I}IDe4 a1e>D Wal-3u07]
ul Sy}eaq pue sase
6T-GIAOD YUM pezeldossy
$10}9e4 (TZ0z Avenue) “1
‘uewinaN 73 “Y “playiey
“qd ‘wesequiepiy

“y “Buaiy20

(panuijuod) *suiysiqnd
a930 ‘saipnis Aanjod
yyeeH 950 “Ayap)a
BY} 10J SAayAOM a1eD

Suiulezyay pue Supeuny
ésaied OYM (070Z) Gd30

PIPE A

 

 

21 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

suase)

A3ZojouyraL

VToyHU Ey Ey]
PLUCBUILIUN Tv et=) |

Serer SL )7
oT RS to R-LVU Co)

“Suluses}

]04]UOD UO!}DAJU! Pad Je} }]V
*sjUap!saJ SUIII] Se YONs ‘syse}
JeoisAyd 4184} YIM Wau} djay
ued Jey} JUaWdINba 0} ssanje
paau siayJoM ‘Sqof awi}-}]n}
JO} sarjiunyoddo paau suayiom
*$10}9S 3129 Wa}-3U0] pue
yyeay Snouen ay} ssosde eos e
aq pynous AyWed uolyesuadwo)
wea} ae) 84} Jo Wed aq pjnoys
SJaYJOM asay “SYyIYs SuU|UaAa
pue Aep Sulinp squapisai xis
Jad (apie ased jeuosiad a")
JayJOM yoddns jeuosiad auo
aAeY 0} SEM UO!epuUsWWOIAL
Jaujouy ‘payiom Ajjenjoe

sinoy aq pynoys siu| “juapisad
Jad Aep jad ased yaulp jo

SAnoy ANOJ JO WNWIU|W e

J8aW 0} Buljjeys BulseaJdU]
dJaM SUOI}EPUDLULWODAI 9U}
SuUOWY ‘SAWOY 2129 WJd}-3U0]
UI S1ayJOM ssaippe 0} Apnjs
SUIJJE}S E PSUOISSILULUOD O12}UO

‘aney Sjuapisel

SUO!}!PUOD dy} U! SUIUIeI}
dAeY P]NOUS SJayYJOM aed
yauiq *Sd1do} aed aniqeljjed
pue enuawap sapnjaul yoIum
‘Bulules} }e9130]}0}U0Ia3

paau osje sasinn

“spaau

aed sjuapisal jo AyIxa}dWo0>
3y} UaAl3 AuyelydAsd a8e-pjo JO
aye 2147193 Ul adua}adwod
]BWJOY aAey pynous

s]uapisas 3ulAjas suelsishyd

‘ssi
pue yyeay Jo uoleUIpsoo
ayeludoidde aunsua 0}
SjUapIsad 1194} JO Spaau ay}
YUM ayesNSUaLULWOD diyssapea}
Jed1UI]9 aAey pjnoys sazI9e4 «
sae Spuepueys asay | *Sai}]/9e}
UI a4ed ]edIPawW JO} spsepueys
sy payepdn Ayain0s aulsipay
2147295 ueadong au} ‘s}uapisas
Ayyioey Sulsinu uo yedu! sj! pue
Dlwapued ay} 0} asuodsai uy}

 

SUIAI] pajsissy
CRY PLR LIES LL

“3ulaq

-}]2M ]e}UaW 41aY} 0} Sys ade}
quadiad 9p pue sysis jesiskyd
992} SUBYJOM JO JUadIAd G9
‘saluyUNOD GDAO SSOJDY
‘uolssaidap pue ‘Ajaixue

yNo Wing YM payelsosse s}
UDIUM SYJOM IJ1US OP SaYJOM
SS.1 Auew ‘Ayunsasu! gol ul
s}NsaJ uawAojdwa Asesodwal
*]04JUOD UO!}DA4UI

ul 8ujUles} ayelidosdde aney
JOU OP UAYo Jes BY} aSNedaq
3D10JYJOM 49 LW1d3}-3U0}

dU} BulDaJJe SABUa|]eYyd ayy
Sunysiysiy si 31wapued ay,
“UdWOM

ade SI9YJOM JO JUdDIAd OG
Ue} BOW *SUOINYSU! UL
YIOM SJaYJOM 429 WU}

-8U0] Jo JUadIAd aA-AYI4

yesauay

Apnys Suyjeys a1e> wie}
-Bu07 (0z0z eunr) ‘dnoi9
Asosiapy Apnys 3uyye3s
d1eD Wa}-3u07 ‘aie Wa}
-3u07 10) As}SIUIW O11e}UQ

*0S9-S09 ‘(7) TT ‘aulzIpaw
314})D11a5 upadoinq *adoing
ul sawoy Suisinu Ul
suelsisKyd 10} a1e> jedIpaw
Jo spsepue}s jo uoldope
]essaniun 10} padu ay}
sy4ysnysiy 6T-dIAOD
*(0Z0Z) *D ‘4 ‘ueW

23 7] "y Suops0y

*o Suossjanwies

**| “eAOsaW]OH

*y ‘sig “d ‘TWIEN.O

Ey PYP ELA

 

 

22 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

PIES 30)

AZojouyraL [Coy pNUE HTD y|
LUCE L RPL) el

‘apew uaagq sey

ssaJZoud a}}}!] pue go0z ul saple
JO} spsepue}s Sulules} }euoleU
JO} paj]ed auld|pay JO 9}NPISU]
ay ‘Bulures} Aue SuuiInbad you
Saj}e}s BLS YUM ‘AyeA Saple
aed }euosiad 10) s}uawauInbal
ajeys pue Sujules} Jo SiNoY GP
Ajuo aney Ajjesauas sapie
uyeay BWOH “InNoy Jad ZTTTS
SeM Saple aed jeuosiad pue
yyeay awoy Jo} adem Aynoy
asdesane au} ‘TOT Ul ‘SPJouaq
Maj pue ‘sadem Jood ‘ewsi3s
aney sqof ay) ‘Auew ase
SJay4JOM paisijenb yo Ajddns
ajdwe ue 8ulaey 0} sasuayjeyD
"SadIMJAS 1194} JO AUC

JOAOD pledipaw pue aedipay,
pue saiauase pasuadi) 10} Yom
Ajjesauas saple yyjeay aWOH
*spunj }euosiad pue d1)Ggnd

Jo uoneulquod e ysnoyy
quatuAed anlaoai sapie asau} jo
qsau ay] ‘saple ased jeuosuad
Jo Juadiad ¢9 Jo sadiAsas ay}
404 AyQoas1p Aed suauinsuoz

‘uolsiAiadns

Japun uoljzey!]1Geuad 10
UO!}IPUOD jedIPawW e aseuew
0} a1e9 Wa}-WOYUs apiAoid
saple yyJeay awoy pue
salyanoe Aylep uM aduejsisse
aplAoid sapie sued }euossadg

“9COT puke 9TOT

uaamyag jUadiad Oy Aq mold 0}
payeafoid si suoiyednd30 asau}
U! SJaYJOM Jo Jaquunu au
“saple yyeay aWOY ase 000‘008
pue sapie ayes jeuosiad ase
UO}! OML “AYJUNWLWOD au}

UI SUIAI] SASSAU]]! SNOLAS YM
a}doad 0} ae) apiAoid sapie
aued }euosuad pue yi]eay awoy
UNI € yNoge “S*7 BY} Ul

ES rTeR i)
pue ase> SWOH

SUIAI] pajsissy
UCR PLR LS

}esauay

“606-206 ‘(9)8€ ‘suIDyY
y}DaH *spaau Zuimois
yeaw 0} Woddns sauinba.
SSAU}}! SNOLIAS YIM
s}ualjzed 10) 2210)410M
peseq-Aylunuiwo> pue
®WOH *(6T0Z) ‘N ueAsg
9 “ys SUewdeyD

Soy " ‘auois ys *‘zyA0d5

PIPE A

 

 

23 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices
REVIEW OF EXPERTS’ RECOMMENDATIONS FOR REFORMING THE LTSS WORKFORCE

LTSS CHOICES

EES 30)

AZojouyraL [iCeyIULa TDs)
PLUCMUUEL UPL)

“sqol

diay ul Ayjiqow puemdn Jo}
Ayunyoddo a}331) sey saply
“quawojdwa

awi}-yed pue sajnpayas

Om ajqeysun aney saply
*SJUA!]D YI] OF

aney Asay} uayM Jnd90 saun{ul
yoeq ‘ajduwexa 104 ‘sqof 4194
Jo spuewap ay} 0} anp salinful
yeoisXyd pue ‘asnqe jeoiskyd
pue jequad aoualiadxa Ady
‘sqol snoJasuep aney saply
*squal]>

WES 9} YUM A}UASISUOD
yom Kay} uaym Way} ul!

Aejs 0} pua} pue uolsiedns
dood 0} anp sqof 41au} aAea}
sJayom Auew ‘uonouny
(S}UAI]D Ul JUBWAAOIGUW! YM
paul] SI Saple aed jeuosued
Jo Ayinujuos ‘sjeyidsoy Jo

asn paseasaul SUIpNjoul pue
$}Ual]9 10} a1ed Aj]enb 100d

0} payul] Uaaq aney sayzed
JOAQUIN} SIH “JUadJad 19 SEM
LT0z ul Ajsnpul ased awoy au}
JO} a7eU JAAOWN} UeIPaW ay}
‘Sulsgua}eyo si saple Sujulezay

CSTR eR U7
pue aie) swWwoH

BUIAI] pajsissy

yesauay

(panunuod)

“606-206 ‘(9)8¢ ‘saleyy
4} eeH ‘spaeu 3ulmoi3
jaaw 0} Woddns sasinbas
SS2U}}! SNOLaS YIM
s}ualjed 10) 3210)410M
peseq-A}lunwiwo> pue
WOH *(6T0Z) *N “ueAIg
3 oy ‘Ss Suewidey) oe

"u ‘auoys “*f ‘zjyads

PIPE A

 

 

24 | AARP Public Policy Institute © 2021 ALL RIGHTS RESERVED | www.aarp.org/LTSSChoices