Presentation to
The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century

January 14th, 2002
Miami, FL

by
Edward Salsberg
Director
Center of Workforce Studies-SUNY Albany

MR. EDWARD SALSBERG: Thank you very much. It's a challenge and it's also a challenge not to speak as New Yorker at the pace of New Yorkers.

I'm the Director of the Center for Health Workforce Studies at the University at Albany, School of Public Health.

I established the Center about five and a half years ago after twenty years at the State Health Department. And my comments today really reflect about fifteen years working on Health Workforce issues, focused on both -- reflecting both the work at the State and at the Center.

The Center is one of a handful of Centers nationally to be dedicated to studying the supply, demand and use of health professionals, and we're one of five Centers that receive support under a cooperative with the federal government.

And we've undertaken a series of studies of recent looking at long term care and Workforce issues and I'll talk about some of those.

Health workers are clearly the heart and soul of our health care system. The availability and quality of health care is directly tied to the health workforce. We cannot provide needed health services without the right number of health personnel in the right location, and we cannot provide quality health services without a well-prepared health workforce.

The nation is facing a health workforce crisis and I'm not talking solely about the crisis that we know of today with the shortages of nurses and home health aides and other workers, and this is a very serious crisis.

But I'm more concerned about the crisis that we're likely to face over the next twenty years and thirty years as the nation ages. And I think unless we take some major steps now that the shortages that we face in the future will be far greater than the shortages we're facing today.

In my written testimony, which I hope you all have a copy of, I've tried to provide the Commission with some basic information on the health workforce. We are data-driven at the Workforce Center and I hope this data is helpful to you.

I've tried to provide data on who the workforce is and where they're working, why were are encountering workforce shortages today, and why these shortages will get worse over the next thirty years.

And I have described what I think the nation needs to do in response to the challenges we face in regards to shortages.

And then finally, I've tried recommend what I think the federal government needs to do, and I want to be clear that I think the federal responsibility is different than the responsibility of the society as a whole. And I think it's particularly important to look at what the federal government can do about workforce shortages.

Let me first try and highlight a handful of the key points of the background. First, as you know, the health care industry is large and is growing. In 2000, there were nearly 15 million Americans employed in health care, either as health professionals or employed in health settings. This is about 11 percent of the nation's workforce. More than 1 in 10 workers in America either works in a health facility or is a health care professional.

The demand for health workers is growing rapidly and we know that. The report includes as an appendix a series of tables from the Bureau of Labor Statistics that recently came out forecasting the demand for workers in the U.S. between 2000 and 2010, and what I've abstracted is the information about the health workforce.

According to the Bureau of Labor Statistics, in the ten-year period, we're going to need about another 5.2 million health workers. The health workforce is growing, the rate of growth and the number of health workers needed is twice, nearly twice the rate of growth of the workforce in the U.S.

So the Labor Department forecasted the growth of about 15 percent in the workforce nationally; health workforce will grow about 28 percent.

The question of course is where we will find those 5.2 million additional health workers. A small point in Exhibit 9, the summary of how many health workers there are, that number is incorrect. It goes from 14 to 19 million; it's actually going from 10.9 million to 15 million.

And the table after it -- or two after it are the percentage growth and fifteen of the thirty fastest growing occupations in the U.S. are in the health field.

I want to point out that the current workforce shortages that we hear about mostly around nursing are really workforce shortages around a whole wide variety of health professions.

Also, it should be clear that the current shortages and the future shortages reflect both short term and long term factors, and I've described some of these factors in the written testimony.

While we can address some of the factors I think relatively easily, including an effective health workforce marketplace, there are some other underlying problems which are difficult to address. And that includes addressing workplace -- problems of workplace conditions and the need to redesign jobs.

But the most difficult task really will be responding to the changing demographics. I think it's quite clear that the population in need of services is growing very rapidly, while the population that most commonly is in the caregiving -- provides our caregivers is not growing or in some cases shrinking.

And I also want to point out while the current -- when we talk about today and 2002, that the current recession is likely to make the shortages less severe over the next year, and they say they have been over the prior two years.

But I want to be clear that we are not addressing the fundamental issues and that really just relates to the short term factor that we had a very full economy. The recession again will help a little, but will not address the longer term issues.

And if you look at the figures, you'll note that the BLS predicts that of those 5.2 job openings, about 1.2 million will be job openings for home health aides, personal care workers and nursing home aides. Clearly, the paraprofessional workforce is critical here, and we're going to be facing very serious shortages of paraprofessionals.

I should also note that the workforce shortages -- we should be concerned about workforce shortages because we don't have the workers that we need, but there are some other effects which may not be quite as obvious, and some of those relate to the quality of care.

And clearly, burnt out and stressed workers cannot deliver the quality of care that we want and expect.

On the other hand, if we can make some progress on workforce shortages, I think we can also make significant progress on improving care and on some other social values and issues.

Now, given the size and complexity of the problems and the multiple causes of the shortages, clearly there's no single solution here. And my testimony includes about a dozen different recommendations that I think we as a nation need to take.

But I want to be clear, as I mentioned, that the responsibility to address the shortages does not lie with government alone, and I do think some of the other parts of the economy, particularly the health and education sector, you know, have begun to look at what their responsibility is.

I am on the American Hospital Association Health Workforce Commission which will be issuing its report in April. And I'm very pleased to see the tone of that report, which is: What can hospitals do about the shortages" and it's not just asking the federal government for more money. It's about how you redesign jobs, how you respond to workers and those are really critical in the long term.

Now, in terms of what the federal government can do, and again, these are outlined in the written testimony in more detail, is first, I think the federal government needs to provide leadership.

One of the difficulties about workforce shortages, and it's similar to some of the housing issues that we heard, is that the responsibility for health workforce and health issues is really spread across a whole wide range of issues between the federal, state and local governments.

We need to have an ability to bring together the diverse interests, and I think the federal government is in a unique position to show leadership on these issues.

Second, I think the federal government needs to increase its investment in the evaluation of the effectiveness of models of organizing services and alternative staffing patterns. The federal government invests billions of dollars looking at the impact of new medical intervention and developments. We spend very little looking at the impact of alternative staffing patterns.

And so what you have is you have usually state legislators left trying to decide whether it makes a difference if there is a minimum staffing ratio of whether there's a difference if a particular professional has exclusive right over a particular set of services.

And we really do need more research and again, this is an area where I think the federal government is best suited to take the lead.

Similarly, the third, I think there's clearly a need for additional support for technology development that support independent living, but also technology that supports workers. We know we have an aging workforce; we need to find ways to reduce some of the physical demands on nurses and others, as well as making better use of information systems technology.

So I think technology holds tremendous, tremendous potential to help us with some of the shortages, and this is clearly an area where federal stimulation and assistance would be of great value.

Fourth, an issue that's been mentioned by other speakers. Just the importance of supporting family and informal caregivers. You know, the good news or bad news is that no matter what we do, I think this nation is going to continue to experience workforce shortages, particularly when we talk about paraprofessionals.

The reality is we don't provide adequate funding for a living wage for many of our home health aides and personal care workers.