Who Will Care for Us?

Long-Term Care and the Long-Term Workforce
Paul Osterman
Paperback or Ebook
6.00 x9.00 in.
232 pages
September, 2017

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Who Will Care for Us? is a comprehensive and probing work on the challenges and opportunities of building a labor force to do some of the most consequential and sensitive work in our society: providing long-term care for others. Paul Osterman analyzes this complicated landscape with clarity and offers new, creative, and tractable approaches to policy.”

—David Weil, dean, Heller School for Social Policy and Management, Brandeis University, and former Wage and Hour Administrator, U.S. Department of Labor

“In Who Will Care for Us?, Paul Osterman provides important insights into the chall- enges and opportunities for the most important members of the long-term care workforce—the certified nursing assistants and home care aides who provide the lion’s share of services to very vulnerable populations. He combines the best of storytelling and robust scholarship to highlight the systemic factors that explain why this profession is so undervalued. As important, he offers a thoughtful range of policy and practice solutions to elevate this workforce and ultimately deliver better services to a diverse and growing long-term care population.”

—Robyn I. Stone, executive director and senior vice president for research, LeadingAge Center for Applied Research

“With the aging baby boom generation, long-term care will be one of the great policy challenges in the coming decades. In Who Will Care for Us?, Paul Osterman identifies one of the key barriers to achieving high-value long-term care: our underinvestment in how we pay and train the direct care workforce. He makes the compelling case that continuing with the status quo is not the answer. He argues for transforming the direct caregiver job to encompass a much wider set of roles. In order for this to occur, we need to not only retrain our workforce, but also reform many of the policies that have led us to neglect our caregivers.”

—David Grabowski, professor of health care policy, Harvard Medical School

The number of elderly and disabled adults who require assistance with day-to-day activities is expected to double over the next twenty-five years. As a result, direct care workers such as home care aides and certified nursing assistants (CNAs) will become essential to many more families. Yet these workers tend to be low-paid, poorly trained, and receive little respect. Is such a workforce capable of addressing the needs of our aging population? In Who Will Care for Us? economist Paul Osterman assesses the challenges facing the long-term care industry. He presents an innovative policy agenda that reconceives direct care workers’ work roles and would improve both the quality of their jobs and the quality of elder care.

Using national surveys, administrative data, and nearly 120 original interviews with workers, employers, advocates, and policymakers, Osterman finds that direct care workers are marginalized and often invisible in the health care system. While doctors and families alike agree that good home care aides and CNAs are crucial to the wellbeing of their patients, the workers report poverty-level wages, erratic schedules, exclusion from care teams, and frequent incidences of physical injury on the job. Direct care workers are also highly constrained by policies that specify what they are allowed to do on the job, and in some states are even prevented from simple tasks such as administering eye drops.

Osterman concludes that broadening the scope of care workers’ duties will simultaneously boost the quality of care for patients and lead to better jobs and higher wages. He proposes integrating home care aides and CNAs into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals. Osterman shows that restructuring direct care workers’ jobs, and providing the appropriate training, could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers.

As the Baby Boom generation ages, Who Will Care for Us? demonstrates the importance of restructuring the long-term care industry and establishing a new relationship between direct care workers, patients, and the medical system.

PAUL OSTERMAN is Nanyang Technological University (NTU) Professor of Human Resources and Management at the M.I.T. Sloan School of Management.


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