Long-Term Care Workforce

Developing a Strategy for a Stable, Sustainable Workforce

Long-Term Population Trends 

Long-term care is a form of care for young and old alike. Typically, this form of care comes into play when acute care is no longer appropriate. When considering long-term care, attention often turns to care for the elderly. As the number of older persons continues to grow along with their longevity, the need for long-term care (LTC) in this vulnerable population will increase significantly for those aged 80 and over, and particularly for older women who tend to live longer. The number of older persons aged 80 and above is estimated to grow from 125 million in 2015 to 434 million in 2050, according to a recent United Nations report.

Executive Director Eleni Papadakis, center, addresses the Health Workforce Council about Washington’s long-term care needs on June 22 in Port Angeles.

Coincidental with the rise in life expectancy and the growth in the number of older persons, the incidence of mental health diseases such as dementia and Alzheimer’s continues to grow. These conditions further increase the demand for LTC, be it in the home or a formal care setting. Around the world, the incidence of dementia is projected to grow from 47 million in 2015 to 75 million in 2030. In the United States, nearly 40 percent of the population aged 85 years and older suffer from Alzheimer’s and dementia.

Further, recent changes in minimum staffing level requirements in skill nursing facilities initiated by the Center for Medicare and Medicaid Services (CMS) has added a level of complexity and urgency to the LTC workforce crisis across the nation.  Urban center SNFs have 3 years to become fully compliant with the new regulations while urban communities will have 5 years to achieve the mandated staffing levels.

Research Efforts supporting the LTC Workforce Initiative

The efforts of the Workforce Board’s Long Term Care Workforce Initiative are supported by the research efforts of an internal Workforce Board research team in partnership with the University of Washington’s Center for Health Workforce Studies.  Lead by Christopher Dula (Workforce Board) and Dr. Bianca Frogner and Dr. Tracy Mroz (University of Washington), the three lead a team that provides cutting edge information that is used to explore innovative efforts to impact the workforce needs of the state and evaluate the impact of existing efforts. The results of the research effort are a key component of the annual reports used to inform elected officials and policymakers about the LTC Workforce.

Statewide Efforts to Staff Long Term Care Services

In 2022, the state Legislature tasked the Workforce Board to lead an effort to address the staffing concerns of LTC employers; specifically, the recruitment and retention of staff needed to provide quality long-term care for Washington residents. Two components were key to these efforts.  1) an establishment of a broad coalition of stakeholders to examine the challenges of staffing in long-term care services in rural and urban settings, challenges that include training and education, recruitment and retention, salary/compensation, public perception, regulatory oversight, and policy mandates. Additionally, the Workforce Board, shares a co-leadership role in the 2) development of an apprenticeship that moves Nursing Assistant-Certified (NA-C) and Home Care Aides (HCAs) along a pathway to becoming Licensed Practical Nurses (LPNs). This pilot program will be the first registered apprenticeship in Washington specifically designed to target front-line LTC providers and create supported pathways to help them progress in the nursing field.

Long-Term Care Initiative participants explore challenges.

Long-Term Care Workforce Initiative

The Workforce Board’s leadership role in the efforts to impact the staffing challenges of LTC providers has led to the formation of the LTC Workforce Initiative.  The 3 year funded project is focused on a broad range of issues related to long-term care industry challenges – from public perception about LTC work, relatively low salary and benefits for workers, and safety and work-life issues that surfaced during the COVID-19 pandemic. Under the leadership of the Workforce Board staff, over 130 professionals in education and training, business community, healthcare providers, state and federal agencies, elected officials, direct care workers, and other interested contributors are considering a range of traditional and innovative proposals to the workforce challenges.

Key to the success of this effort – the Long-Term Care Workforce Initiative – is the collaborative approach to long term solutions. In evidence, the Department of Social and Health Services (DSHS) Aging and Long Term Services Administration (ALTSA) and the Workforce Board routinely contribute to complementary efforts of the two independent agencies. ALTSA’s Workforce Recruitment and Retention efforts and the Direct Care Workforce Collaborative support the efforts of the LTC Workforce Initiative.  ALSTA’s efforts are likewise supported by the convening of monthly meetings of four unique subcommittees to hold open discussions, share ideas, and develop strategies that can efficiently and effectively realize changes to the existing workforce challenges.

Licensed Practical Nurse Registered Apprenticeship Program

Planning for the LPN Registered Apprenticeship Program began in 2021 with the Nursing Commission (now, Washington Board of Nursing (WABON)) laid the foundation for the innovative program that is the first of its kind in the country.  In 2022, the legislature mandated that the Workforce Board, the Washington State Board of Nursing (WABON), and the Department of Labor and Industries (LNI) collaborate to advance the work of WABON.  In November of 2023, the Washington Healthcare Association (WHCA) was awarded a contract, after a competitive bidding process, to sponsor the LPN Apprenticeship.  WHCA now is the operation lead responsible for the day to day operations of the apprenticeship which is expected to produce its’ first cohort of apprentices in the Fall of 2024. Working in partnership with the three state agencies, three employers (Pennant, Hyatt Family Facilities – Landmark Care & Rehabilitation, and Brookdale) and two community colleges (Edmonds College and Yakima Valley College) have each committed significant time and resources to this project.

Department of Veteran Affairs Apprenticeship

An ongoing partnership between the Washington Department of Veterans Affairs (DVA) and the Workforce Board is facilitating the development of an LPN Registered Apprenticeship Program. Since January of 2023, the Workforce Board, WABON and L&I have contributed to the efforts of the WDVA to establish a pilot apprenticeship program in the first of their four facilities.

The DVA program will be distinct from the Workforce Board, WABON, and LNI’s efforts with private employers but will draw from the experiences of that effort. DVA is also working to develop a new job classification for their facilities – a nursing technician. This classification is a key component in the transition to an LPN and in ensuring wage growth for apprentices. DVA’s effort is strongly supported by the Workforce Board.

Annual Report

The Workforce Board is demonstrating its commitment to transparency by drafting annual reports to the Governor’s Office and the Legislature. These reports detail the states’ ongoing efforts, accomplishments, and next steps for the multiple projects.  You can find the 2023 report here.

LTC Summit

In July, 2024, we held the first LTC Summit co-sponsored by the Workforce Board and The Department of Social and Health Services.  The one day live meeting of LTC leaders from across the state convened at the Cedarbrook Lodge in Sea Tac, WA.  The summit featured a keynote address from Dr. Kezia Scales, Vice President of Research and Evaluation at PHI, and a panel discussion of LTC workforce by representatives of federal agencies.  In addition, a facilitated conversation was held with a host of direct care providers who shared their experiences and challenges as they perform their daily work duties.

Contact the Workforce Board

The importance of holding comprehensive discussions on the provision, quality, and funding of long-term care for disabled persons and older persons concerns not only the well-being of care recipients, but also of informal caregivers and families, and ultimately, the sustainability of government healthcare and social service systems. If you are interested in contributing to these efforts or would like more information, contact LTC Workforce Policy Manager Dr. Donald Smith at Donald.smith@wtb.wa.gov,  or Michelle Pierce at michelle.pierce@wtb.wa.gov.