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What If We Run Out of LTC Workers?

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George Friedman thinks a conflict over hordes of Mexicans who move into the United States to care for old people will lead to a kind of cold war in North America in the 2070s.

Two Gamma Inc., Denver, is trying to fill the coming long-term care (LTC) worker gap with robots. Right now, the robots are better at bringing an older person a meal on a tray than keeping someone with Alzheimer’s disease from leaving the house to go who knows where.

Lisa Rill, a social worker and elder care policy specialist at Florida State University, is suggesting that the United States ought to consider filling the gap the old-fashioned way: By figuring out how many workers we’ll need for the LTC job and making sure that we’re training them.

Rill talks about strategies for dealing with the gap in a study she prepared for the Society of Certified Senior Advisors Denver.

Rill’s analysis might be of interest to people in the long-term care insurance (LTCI) community because the LTC labor supply could affect how much care LTCI holders will be able to afford and what type of care they will get.

Government forecasters expect the number of people who are using paid LTC services to increase to 27 million in 2050, from 15 million in 2000.

Typical “old old” Americans will have fewer children in coming decades than they do today, and the share of the U.S. population made up of people ages 18 to 65 will be falling, Rill says.

The LTC workforce would have to grow 2% per year to keep up with the expected increases in demand but appears to be growing just 0.3% per year, Rill says.

The government contributes to the tight LTC labor supply by imposing training standards, minimum patient-to-staff ratios, and government program reimbursement rules that affect how many people are qualified to apply for LTC jobs and how much LTC workers will earn, Rill says.

“We must address this shortage of skilled LTC employees by ensuring the availability of a large and competent paid LTC workforce,” Rill says.

A committee affiliated with a federal government advisory body, the Institute of Medicine, called in 2008 for addressing the LTC labor shortage by doing a better job of preparing all health care and personal care workers to work with the elderly, improving efforts to recruit and train LTC workers, and improving the way LTC services are provided, Rill says.

One simple step the country could take is to standardize the number of hours direct-care workers, such as home health aides need to have, Rill says.

Today, Rill says, the minimum number of hours an aide needs could range from 75 hours in some states up to 175 hours in others.

In some cases, Rill says, the government has paid more for care specifically to increase workers’ pay, but the extra money does not always reach the workers.

The U.S. Labor Department has tried to help by developing LTC apprenticeship programs, and two foundations, Atlantic Philanthropies and the Robert Wood Johnson Foundation, backed 5 state LTC worker job improvement pilot programs.

Some states made substantial changes in LTC management practices, but “there was no evidence that the implemented practice changes improved direct-care workers’ jobs,” Rill says.

Rill recommends that senior advisors take the possibility of an LTC labor shortage seriously.

“Take a step back, look at the bigger picture, and ask yourself, ‘What are the major problems in the long-term care system that lead to poor quality of care?’” Rill says. “What is being done on the federal and state levels to improve the system? How do I fit into the equation? What can I do to help improve the situation?”

What if the United States fails to figure out how to increase the domestic supply of qualified LTC workers — and also fails to produce robots or other machines that can increase the productivity of the care workers who are available?

Friedman, the head of an Austin, Texas, geopolitical analysis firm, suggests in his book, “The Next 100 Years,” that the United States may soon replace the fences that now keep Mexican immigrants out with signs inviting Mexicans to come on in and tend to our elderly.

As more Mexican-born LTC workers become U.S. citizens and gain the right to vote in the United States, and as more Mexican LTC workers vote in Mexican elections, the status of those workers could become a major source of tension between Washington and Mexico City, Friedman says.