Strengthening the Workforce to Support Community Living and Participation for Older Adults and Individuals with Disabilities Proceedings of a Workshop (2017) / Chapter Skim
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2 Characterizing the Users and Providers of Long-Term Services and Supports
2 Characterizing the Users and Providers of Long-Term Services and Supports
Pages 7-24
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From page 7... ...
Luis Padilla, associate administrator for health workforce at the Health Resources and Services Administration (HRSA) , then discussed his agency's efforts to develop the necessary workforce to meet those needs.
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The relative distribution changes as people age, said Kaye, such that in the workingage population, back and spine problems are the leading causes of needing long-term services and supports, followed by intellectual disability, arthritis, mental health issues, and heart conditions. As people reach much older ages, physical disabilities become more prevalent than cognitive disabilities, and arthritis becomes the leading reason for needing long-term services and supports, followed by back and spine problems, heart conditions, dementia, and diabetes.
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From page 9... ...
Again, Kaye said, most of these individuals get help from unpaid sources, with only 14 percent getting paid help. Individuals in the community who also need help with activities of daily living2 total about 1.4 million people, and 20 percent of these individuals receive those services from paid help.
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From page 10... ...
10 TABLE 2-1 Types of Assistance Needed by Users of Long-Term Services and Supports Number of Percentage of Percentage of Activities for Population Population Level of Which Help Is Population Receiving Receiving Paid Need Needed Typical Activities for Which Help Is Needed (millions) Unpaid Help Help Low 1–2 Getting out into the community and/or 6.6 93% 8% housework Medium 3–5 Low level activities and preparing meals and/ 3.0 92% 14% or managing medications and/or managing money High 6–8 Medium level activities and bathing and/or 1.4 91% 20% dressing and/or transferring Very high 9–10 High level activities and eating and/or 1.1 89% 22% toileting NOTE: Based on 2010 data from the Census Bureau Survey of Income and Program Participation.
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From page 11... ...
The respondents to that survey said that their top need was for homemaker or chore services, followed by transportation and personal care services. They also reported needing more help with companion services, vehicle and home modifications, home health services, technology and equipment, home-delivered meals, and housing.
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From page 12... ...
One model features agency-employed, technically trained home health aides, often credentialed as certified nursing assistants or similar titles, while the other paradigm, which Kaye said is favored by the independent living movement, focuses on personal care attendants who are chosen by the consumer, work as independent providers, and may or may not be family members. The first model emphasizes the provision of health care–type services, while the second model emphasizes the communication and listening skills that are critical to understanding and following the consumer's instructions.
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"I want to urge people who are thinking about worker training to consider the trade-offs between requirements for training and barriers to workforce entry, which do seem to be worsened by requirements, and the trade-off between these requirements and the consumer's desire for choice and control and the ability to hire independent providers, including their family members," Kaye said. GOVERNMENT PERSPECTIVE ON THE WORKFORCE PROVIDING LONG-TERM SERVICES AND SUPPORTS Luis Padilla Associate Administrator, Health Workforce Health Resources and Services Administration The combination of an aging population and a growing number of individuals with disabilities is increasing the demand for both licensed
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From page 14... ...
The Workforce Landscape HRSA's mission is to improve health and achieve health equity through improving access to quality services, a skilled workforce, and innovative programs, said Padilla. To serve that mission, HRSA considers the multiple factors that produce an effective workforce in health care delivery.
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From page 15... ...
For example, 22 states are expected to have a shortage, not a surplus, of licensed practical nurses by 2025. Complicating the matter further, some sectors of the health care workforce have proportionately fewer providers living in rural areas, regardless of education and training.
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program, a community-based organization that serves older adults through 12 senior centers, Meals on Wheels, and a licensed home care services agency. In addition, the grantee is promoting inter-professional education that is focused on the unique care needs of older adults by training more than 600 health professionals and 1,000 of RAIN's home health aides on how to provide care for adults with dementia, and it is teaching more than 60 community volunteers how to educate older adults on staying healthy through smoking cessation, exercise, good nutrition, and managing chronic diseases such as asthma, congestive heart disease, and diabetes.
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From page 17... ...
In addition, because many individuals with disabilities receive their health care through Medicaid, HRSA focuses on improving access to care for this population. The MCHB has two other programs specifically focused on the pediatric population: the Leadership Education in Neuro evelopmental d and Related Disabilities Program5 and the evelopmental–Behavioral D Pediatrics Program,6 which focuses on preparing health professionals to work with children with autism spectrum disorders and developmental disabilities and their families.
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From page 18... ...
Merging the Medical and Social Models of Care Margaret Campbell of Campbell & Associates commented that the two presentations highlighted for her the disconnect she sees between the medical model and the social model of care. She said she was struck by Kaye's statement that the main barrier to community participation is health limitations.
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From page 19... ...
Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for indi viduals and community health needs, and provide services such as first aid and blood pressure screening.
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From page 20... ...
He also suggested that if the nation's care model moved toward the middle of Kaye's care continuum, i.e., to a model that integrates the medical and social models of care, then this strategy could reduce the financial burden of the workforce shortage so that there would be enough money and enough workers in the system to meet the long-term services and supports demands of older adults and people with disabilities. "The intensity of services that I have to provide to one individual, because we wait until they are in an acute episode, could be spent on multiple individuals if we caught them earlier in the continuum," said Johnson, and he said that this might also help reduce the workforce shortage.
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From page 21... ...
Whether the new regulations in Washington State reduced access is not yet clear because the state has not implemented quality measures that would indicate whether access to care or quality of care has been affected by these regulations. Kaye stressed the importance of involving consumers and disability advocates in any discussions prior to implementing increased training requirements.
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From page 22... ...
The health profession, he said, is "abysmal" with respect to health diversity and has been for the past 30 years despite powerful efforts to induce change. There are also more areas than ever with shortages of health professionals, particularly in rural and underserved areas where many of these populations reside.
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From page 23... ...
How do you make that happen more often than it does now? " Fulmer ended the discussion by noting that the United States spends $1 trillion on hospital care and $4 trillion on all health care.
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