EWA Urges Support for Critical Eldercare Workforce Programs

The Eldercare Workforce Alliance (EWA) released the following statement on President Trump’s America First: A Budget Blueprint to Make America Great Again:

The Eldercare Workforce Alliance is deeply concerned by the cuts proposed in the Budget BlueprintPresident’s budget blueprint. As offered, the blueprint drastically reduces critical health workforce training programs, cuts health research funding, and eliminates much-needed home- and community-based services for older adults across the county. At a time when our nation is rapidly aging, EWA urges Congress to provide adequate funding to ensure our eldercare system can provide high-quality care to older adults.

EWA is particularly concerned about the Title VII and VIII Geriatrics Workforce Enhancement Program (GWEP), given the administration’s intent to cut $403 million from the Department of Health and Human Services’ health professions and nursing workforce training budget. The GWEP is the only federally-funded program dedicated to training health professionals, family caregivers, and consumers in the unique needs of older adults. The community-based GWEPs aim to develop a health care workforce that maximizes patient and family engagement while improving health outcomes for older adults, providing a critical service in communities across the country.

In addition, EWA urges support for the vital health research activities conducted by the National Institutes of Health and National Institute on Aging, which increase our understanding of many of today’s most pressing health care challenges, including Alzheimer’s disease and related dementias. EWA also supports home- and community-based programs, like the services offered through the Community Services Block Grant, that allow older adults to receive high-quality care in their homes.

We appreciate the President’s proposal to provide additional funding to the Department of Veterans Affairs (VA). The VA plays a critical role in both providing high-quality care to our older veterans and training the geriatrics and gerontological health workforce. We look forward to working with President Trump and Congress to craft a full budget that recognizes the value of programs that train health care professionals, provides adequate funding for research into lifesaving medical advances, and supports programs that allow older Americans to live well in their homes and communities.

Keeping our Eyes on the Ball

By Amy York, EWA Executive Director

As we jump into 2017, this year is already about big transitions. We have a new President and Congress proposing substantial changes in many policy areas, including a major overhaul of our health care system. Many of our baby boomers are now 70 and will need significant care as we age. Workforce preparation for this care continues in a slow, piecemeal approach. At this point, it would be easy to get distracted.

To ensure we remain focused on workforce and family caregiving policies that advance a meaningful system of care with real choices for older adults and their families, EWA’s 2017 policy agenda will be focused on the following:

  • Support the Geriatric Workforce Enhancement Program (GWEP) reauthorization and increased appropriations. In 2015, the Health Resources and Services trainingAdministration (HRSA) funded 44 GWEP community centers in 29 states with a specific focus on ensuring that primary care clinicians have the skills and knowledge to care for older adults. We are encouraged by the program’s early successes but we know we need to expand its reach to meet the growing need. In our communications with Congress and the Administration, we will highlight the flexibility this program provides communities and urge geographic expansion of the program especially in rural areas where workforce shortages are more pronounced.
  • Support the recommendations in the 2016 Families Caring for an Aging America report by the National Academies of Sciences, Engineering, and Medicine (NASEM). Specifically, EWA will advocate for development of a national strategy to support family caregivers, additional funding for caregiver support programs, and training dollars for both the paid workforce and caregivers.
  • Develop and share information\data on how the proposed changes to our health system, such as repeal of the Affordable Care Act (ACA) and Medicaid block grants will impact the spectrum of workers who care for older adults. In particular, EWA will look at how these changes could affect the ability of our workfor
    ce to provide quality, coordinated care to older adults and their families. We will emphasize the importance of health care jobs, especially in rural areas, as key divers of economic growth and community stability.
  • Highlight innovative programs and models that provide high-quality, integrated care, especially those at the Department of Veterans Affairs. EWA will continue to share information about programs that recognize the unique needs of older adults and provide care through a team-based, patient and family centered approach.
  • Develop a State Based EWA Coalition Tool-Kit. EWA is working with Amanda Borer, a Health and Aging Fellow, to establish a North Carolina eldercare wokissing-forehead_000010309449mediumrkforce alliance. It will bring together GWEPs, EWA members, and other state advocates to discuss ways they can work together on state policy initiatives. Our hope is to use this example to draft a tool-kit to establish similar coalitions in other states.

The challenge for all of us is to fight for the programs that form the basis of our care system for older adults and launch new initiatives to advance and prepare our eldercare workforce. We are committed to raising concerns about how reforms could impact the workforce and those we care for, but at the same time, EWA must offer solutions to move beyond the status-quo.

As the voice of the eldercare workforce, we look forward to working with our coalition members, aging and health workforce stakeholders, and policy makers to build the eldercare system that our grandparents, parents, and ourselves deserve.

What President-Elect Trump Means for the Eldercare Workforce

By Jessica Nagro, MPA
Policy & Communications Manager
Eldercare Workforce Alliance

In November, the United States elected Donald Trump to serve as the 45th president. While this is a dynamic time for the transition, President-elect Trump has provided several signals for what his administration might mean for the eldercare workforce and America’s older adults.logo

Here is what we know so far:

Campaign Promises
Throughout the campaign, President-elect Trump made several statements on issues related to the eldercare workforce. For family caregivers, Trump has proposed to allow working individuals to deduct eldercare expenses from their federal income taxes. The deduction will be capped at the average cost of care for the state of residence. In addition, he wants to establish new Dependent Care Savings Accounts (DCSAs) so families can set aside extra money to offset eldercare expenses, including long-term care costs, for their parents or adult dependents.

More broadly, Trump has promised to “work with Congress to create a patient-centered health care system that promotes choice, quality, and affordability.” He also indicated he plans to block-grant Medicaid but promised to keep Medicare coverage intact.

First 100 Days
Shortly after the election, President-elect Trump released his plan for the first 100 days of his administration. The document outlines several ways he plans to work with Congress to alter the health care and eldercare systems. Trump urges Congress to fully repeal and replace the Affordable Care Act (ACA or Obamacare). He proposes to replace it with Health Savings Accounts, the ability to purchase health insurance across state lines, and more flexibility for states to manage Medicaid funds. The President-elect also hopes Congress will take up his Affordable Childcare and Eldercare Act that enacts his caregiving platform detailed above.

Federal Appointments
In late November, President-elect Trump announced his candidates for Secretary of Health and Human Services (HHS) and Administrator of the Centers for Medicare and Medicaid Services (CMS).

Trump nominated Congressman Tom Price (R-GA) to serve as Secretary of HHS. Congressman Price, an orthopedic surgeon, has served US House of Representatives since 2005 and currently serves as the Chairman of the House Budget Committee. In Congress, he is a leading conservative voice on health care and often advocates for more state and local control of health care policy administration. He supports Trump’s proposals to repeal and replace the ACA and block-grant Medicaid but Price has also spoken about making substantial reforms to the Medicare program.

President-elect Trump also nominated Seema Verma as CMS Administrator. Verma is a health care consultant who assisted Governor Mike Pence (now Vice President-elect) in designing Indiana’s Medicaid expansion under the Affordable Care Act. Her consulting company also assisted with other Medicaid expansion plans brought forward by Republican governors. Both Price and Verma are subject to Senate confirmation.

As our society continues to age, the coming years will be a critical time for eldercare issues. We look forward to working with our coalition members and interested stakeholders to ensure we have a health workforce prepared to care for our older loved ones.

#TalkBrainHealth: Starting the Conversation on Brain Health and Memory

As we age our brains do, too. If you are noticing changes in an adult in your life, it may be time to talk about brain health. Perhaps your loved one is having a hard time remembering things; they may act differently or struggle with everyday activities. To aid in starting a conversation about brain health and provide resources, the National Alliance for Caregiving and the Alzheimer’s Foundation of America created the #TalkBrainHealth Tool Kit. The Tool Kit can be used to gather information, find resources, and talk with family, friends, and health care professionals about the health and well-being of your loved ones.

tbhOften, the first time people notice these changes is during the holiday season—especially if we live some distance away from our loved ones. Because of this, many people may hesitate to have a conversation about it with their loved ones. But talking about brain health and memory concerns doesn’t have to be scary.

Here are some tips to consider in determining whether and how to start a conversation, ways to promote brain health, and next steps:

  1. Remember, it’s normal for our brains to change as we get older. Some changes associated with normal aging include changes in daily activities, such as driving less, occasional forgetfulness, or some difficulty understanding instructions and making decisions. If you notice changes beyond those listed above, it may be time to create a plan and help the person get the support they need.
  2. Adopt a brain healthy lifestyle. Join your loved one on a journey to promoting optimal health. Eat a diet rich in whole grains, Omega-3 fatty acids and antioxidants. Get moving! Start a regimen best-suited to your loved one’s need. Track your progress together. Also, be sure to get a good night’s sleep.talkbrainhealth_tool-kit-thumbnail-234x300
  3. Time to have a conversation? Be mindful of things like tone, word choice and body language. Keep in mind that there are a number of reasons someone could be having a memory problem, including vitamin deficiencies, thyroid problems, and depression. Using words like “Alzheimer’s” and “dementia” can be jarring. Keep in mind how your choice in words, body language, and tone will be perceived by your loved one. Be supportive and let the individual know that they are not alone.
  4. Caregivers, get help to follow through with your next steps. Managing brain health or memory issues, sometimes along with other health care needs, can seem daunting. Tap into your support system—family members, friends, community organizations—for help. Scheduling and going to appointments, managing follow-up visits, and monitoring any further changes in the individual are all tasks that can be assisted by others to ease the stress of caregiving.

For more details on these tips and additional information on how you can start a conversation on brain health this holiday season, download the Talk Brain Health toolkit at www.caregiving.org/talkbrainhealth.

#TogetherWeCare Update

This Labor Day, EWA asked partners to help us recognize, celebrate, and support the eldercare workforce.

Each year, on the first Monday in September, our country comes together to celebrate the contributions American workers have made to the strength of our nation. This year, we wanted to focus on the often over-looked eldercare workforce and reinforce the importance of the work they do each day. Whether it be health professionals, social workers, family caregivers, direct care workers, or others, these individuals play a critical role in keeping our loved ones healthy.

In order to join in the movement, we asked individuals to share their own care story. Many of us are providing care to an older adult but most of us don’t realize how many of our friends, neighbors, and colleagues are facing similar experiences. By putting a face on caregiving and the eldercare workforce, it reinforces that this isn’t an individual experience and ways to support this workforce are not an individual endeavor.

Here is a taste of the stories shared during the initiative.

LeadingAge President and CEO Katie Smith Sloan authored “Honoring Workers on Labor Day

Robert Espinoza, Vice President of Policy at PHI, weighed in with “Who Will Care For Us As We Age? New Research Raises Big Questions”

You can also find more eldercare workforce stories on the EWA website.

You can see a full recap of the stories shared via Twitter and please continue to share your care story using #TogetherWeCare! 

The Inextricable Link between the Eldercare Workforce and Family Caregiving

By Terry Fulmer, PhD, RN, FAAN
President, The John A. Hartford Foundation

Are you a caregiver? Sooner or later, caregiving touches us all.

According to a new report by the National Academies of Sciences, Engineering, and Medicine, Families Caring for an Aging America, nearly 18 million individuals currently provide care to an older family member, spouse, or friend. Millions more anticipate serving in a caregiving role in the future. Most of us, as we age, will eventually become care recipients.


For individuals and for society as a whole, the preparation of our nation’s workforce to address caregivers’ needs should be of paramount concern.

Family caregivers are a large and absolutely critical component of our health care workforce. They are the primary providers of care for our nation’s older adults, yet they remain almost invisible. While they perform a host of vitally important activities, from meal preparation and house cleaning to complex medical tasks like wound care, they often do so with no training, limited support, and little recognition.

As the Academies’ report documents, our fragmented health care system and the demands it places on families often result in physical, emotional, and financial challenges for these heroic caregivers, which puts their loved ones at risk. This is unsustainable, dangerous, and wrong.

The good news is that health and social service professionals, as well as direct care workers such as home health aides and nursing assistants, are in a unique position to support family caregivers. To make that possible, we must work to create a health care system that is not just person-centered, but also family-centered, as called for in the report. The entire care workforce needs to be equipped with training and systems that support this transformative approach.

One key initiative is the Health Resources and Services Administration’s Geriatrics Workforce Enhancement Program (GWEP), which The John A. Hartford Foundation is proud to be a partner of through support for a national coordinating center. This important federal program is integrating geriatrics into primary care through 44 academic-community partnerships across the country. Through the GWEP sites, various members of the health care team are trained alongside family caregivers. This is a critical step to developing an inter-professional workforce that includes these caregivers.

kissing-forehead_000010309449mediumUnfortunately, as the report notes, the GWEP program does not have adequate funding to meet the range of training needs, or the proper geographic distribution to affect true systemic change. To fully support family caregivers and properly train the entire eldercare workforce, both paid and unpaid, programs such as the GWEP need to be valued and expanded.

In my own work as a geriatric nurse, and among my friends and family, I have seen the enormous strain on caregivers. I have seen how our system too often excludes them from important decision-making, yet assumes they are willing and able to do this very difficult job. I am so pleased the Academies have committed to shining a light on this often overlooked constituency and am optimistic that the report’s recommendations will catalyze change.

This report, and the work of organizations like the Eldercare Workforce Alliance, which we also proudly support, have the potential to move family caregivers into the forefront of health system reform and policy discussions. We owe it to family caregivers to prepare them to be full partners in the health care system, and to build that system so it can do more to care for the families caring for our aging America.


This Labor Day #TogetherWeCare

This Labor Day, EWA hopes you will join us in recognizing, celebrating, and supporting the work of the eldercare workforce.

Each year, on the first Monday in September, our country comes together to celebrate the contributions American workers have made to the strength of our nation. This year, we want to recognize the often over-looked eldercare workforce and reinforce the importance of the work they do each day. Whether it be health professionals, social workers, family caregivers, direct care workers, or others, these individuals play a critical role in keeping our loved ones healthy. And due to the aging of our society, we will be even more reliant on the eldercare workforce as it is estimated that by 2030, 3.5 million additional health care professionals and direct-care workers will be needed to adequately care for our older loved ones.

As we take steps to elevate the work of these individuals, we also know there is much to be done to strengthen this workforce. Training, career advancement, improved job quality and pay, and the expansion of team-based care models are just a few of the strategies we can explore to ensure our workforce is adequately prepared to care for our aging society.

In order to join us in this movement, we hope you will share your own care story. Many of us are providing care to an older adult but most of us don’t realize how many of our friends, neighbors, and colleagues are facing similar experiences. By putting a face on caregiving and the eldercare workforce, it reinforces that this isn’t an individual experience and ways to support this workforce are not an individual endeavor.

Join the conversation on Facebook and Twitter with #TogetherWeCare to share your eldercare workforce experience.  


Millennials: The Next Generation Elder Care Workforce

By Rebekah Paxton, EWA Summer Intern 

A few weeks ago, the American Society on Aging hosted a panel focused on the latest edition of Generations, specifically on bolstering the eldercare workforce for the future.

Much of the conversation surrounded expanding the workforce—training any and all existing health workers in the principles of geriatrics, and attracting new individuals to the aging field. The conversation was important and speakers expressed frustration that not enough national attention was focused on the looming workforce crisis. In addition, audience members raised the important point that in discussions of workforce expansion, not enough attention is paid to attracting young people into the field of aging.

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With our rapidly aging society, the lives and careers of younger individuals will increasingly be focused on caring for our older adults. However, the field faces unique barriers in attracting young professionals to the areas of geriatrics, gerontology, and aging policy. Many of these individuals, like myself, do not directly feel the urgency of a skyrocketing aging population or a workforce shortage. In addition, many young people have not been exposed to working with older adults and therefore feel uneasy about choosing aging as a career path.

In reality, however, aging issues will impact us all. Today’s young adults are the next generation of medical professionals, care workers, and family caregivers. By 2030, EWA projects that the U.S. will need 3.5 million more healthcare professionals & direct-care workers to meet demand for care needs. Unfortunately, many medical and care professionals are not trained to address the unique needs of older adults, and there is limited flow of new medical professionals in to geriatrics. This is due, in large part, to the financial and advancement barriers inherent in the aging field.CIAW Gordon

In addition, in Washington, D.C. and state capitals across the country, many policy positions are filled by college students and recent graduates. As interns and young professionals, these individuals are often first points of contact in Congressional offices, advocacy organizations, and research firms and can play key roles in educating lawmakers and organizational leaders.

It is imperative that these young professionals understand the distinctive challenges faced by an aging society and elevate aging issues in their work. In order to bring more young people into the conversation about aging careers, organizations and professionals in the field need to get creative about appealing to this demographic. As a young professional, I believe there are several steps aging organizations and advocates can take to demonstrate the value and importance of careers in the field. Here are a few examples:

  • Directly recruit young people by boosting presence in college job fairs, career panels, and with career development offices
  • Create meaningful internship, fellowship, and residency experiences that give hands-on experience and on-the-job training
  • Advocate for the presence of geriatrics and gerontology training in medical school coursework and incentivize this field through financial assistance
  • Increase salaries and opportunities for advancement as well as additional opportunities for training for the entire workforce
  • Educate students and young professionals about the growing field of technology for aging adults
  • Meet with young policy professionals to educate about the importance of being involved in conversations about aging

Attracting a younger demographic to the aging field can increase the attention paid to these critical issues. We all are impacted by aging, whether by caring for a loved one or experiencing aging ourselves. We also increasingly face a reality where our aging society will cause budgetary constraints and crowd out other priorities. With the increased demand for jobs in the aging field and the rewarding nature of the work, jobs in geriatrics and gerontology are great career paths for younger generations. Young people need to be involved in the solution to care for our grandparents, our parents, and ourselves and I hope other young adults join me in the work.

Rebekah Paxton is a rising junior at Boston University studying political science and economics. She interned with EWA this summer.

Special thanks to Mairead Bagly, who is currently interning with LeadingAge, for providing ideas about how to get young people involved in aging.

Direct-Care Crisis Is an Opportunity: Let’s Take It

By Jodi M. Sturgeon

Today’s United State of Women conference at the White House includes among its themes, women’s economic empowerment. Women continue to earn 79 cents to every dollar a man earns. For women of color, the gap is even larger. African-American women earn 63 cents for every dollar earned by a man, Latinas, 54 cents.

There are multiple reasons for the stubborn persistence of these numbers, but one is certainly job segregation. Most female-dominated professions pay less than those dominated by men, and this is most certainly true of care work. Despite the immense value to society and the skills needed to do the work well, elder care and child care workers earn wages far below workers in male-dominated occupations such as construction, transportation, or maintenance and repairs.

In the lasScreen Shot 2016-06-14 at 8.50.35 AMt year, PHI has published two reports that shine a spotlight on direct-care workers, occupations that are 90 percent female. In the first, Paying the Price, we examined the poor quality of home care jobs. Home care workers—personal care aides and home health aides—earn average wages of $9.61 per hour. Despite the ever-increasing demand for these workers, real wages (adjusted for inflation) have dropped 5 percent over the last decade.

Home care workers’ wages are further impacted by the way home
care jobs are structured: nearly 60 percent of the workforce works part time. The result is a median annual income of $13,000. Wages are so low that more than half of home care aides live in households that rely on public assistance to support their families.

Raise the FloorIn a second report, Raise the Floor: Quality Nursing Home Care Depends on Quality Jobs, PHI examines wages for nursing assistants working in over 15,000 nursing homes nationwide. For these workers, the median hourly wage is $11.51. These workers also have difficulty getting full-time work, reducing median annual incomes to $19,000. One in three nursing home workers lives in a household relying on public benefits.

These low wages, along with other job quality issues such as insufficient training, limited on-the-job support, and inadequate career paths, lead to very high levels of turnover in both home care and nursing home jobs, affecting the continuity and quality of care for consumers. The Eldercare Workforce Alliance came into existence following the 2008 Institute of Medicine report, Retooling for an Aging America, that highlighted, among other issues, the serious problems facing our nation if we did not invest more in the direct-care workforce. Yet little has changed.

Why do wages remain so low despite the impact of poor quality jobs on consumer care? That brings us back to the United State of Women, and the marginalization of this predominantly women of color workforce. Competing against more powerful economic interests—those of providers, consumers, and state and federal governments that benefit from low wages—direct-care workers haven’t been able to change a deeply ingrained system that accepts high turnover and compromised care quality as the price of keeping costs down.

But in a recent article in Generations, Steven L. Dawson argues that that dynamic is changing, in part because of our country’s changing demographics. High demand for direct-care services, along with a shrinking pool of paid caregivers, is rapidly increasing vacancy rates. Providers unable to meet the needs of potential clients are feeling the pain more acutely than they have in the past. Consumers, too, perhaps facing early retirement because they cannot find someone to assist a loved one, may have to reassess the value of care. And state Medicaid programs, despite the desire to keep costs down, must attract enough caregivers to support community living.

As economist Paul Romer has said, “a crisis is a terrible thing to waste.” With the shift in economic incentives for long-term care stakeholders, we have a window of opportunity to press for systemic changes in how we train, compensate, and support direct-care workers. An empowered workforce that is respected and valued, and compensated appropriately, will contribute greater value and strengthen our overall system of care. That is worth paying for.

Jodi M. Sturgeon is the president of PHI, the nation’s leading expert on the direct-care workforce. PHI advocates for improving the quality of care for elders and people living with disabilities through improving the quality of jobs for direct-care workers.

Is the Eldercare Workforce Ready?

As we come to the end of another Older American’s Month, it is a good time to assess the progress we are making in the development of our eldercare workforce.

It has been eight years since the Institute of Medicine released its groundbreaking report, Retooling for an Aging America: Building a Health Care Workforce. Policymakers and professionals continue to recognize that we must address this issue. In 2013, the U.S. Senate Commission on Long Term Care described the workforce as the “critical link in the availability and quality of services for our nation’s elders.”


Unfortunately, we are a long way from a well-developed, quality eldercare workforce. Resolving the workforce crisis requires addressing recruitment, retention, training, and compensation issues across the direct-care and professional health care workforce-which is essential to improve the quality of care and quality of life for older adults.

We must:

  • Increase pay and job quality. They are critical to ensuring adequate recruitment and retention. Half the direct care workforce turns over every year and the average wage in 2013 was $9.61 an hour. In less than two years, by 2018, more than one million direct care workers will be needed.
  • Training the entire workforce, especially primary care providers, in the unique needs of older adults is critical. Many older adults will not have access to geriatricians. Currently, there are only 7,029 geriatricians practicing in the U.S., roughly half the number needed. It is therefore critical that the primary care workforce is trained in geriatrics and gerontology.
  • Expand the Geriatrics Workforce Enhancement Program (GWEP). The GWEP is the only federally funded geriatric training program. The innovative program is training the entire workforce, family caregivers and consumers in the care of older adults. However, the $38.7 million program is only in 44 communities and 29 states. There are large geographic areas, especially rural areas, that have no programs. Yet, rural populations are growing increasingly older.
  • Develop additional incentives to go into geriatrics and gerontology. Right now, there are many disincentives to go into the geriatrics specialty. For example, geriatricians make less than half as much as a number of other specialties. A majority of medical students carry thousands of dollars of debt coming out of medical school. When it comes time to choose a specialty, salary is an important component. Providing incentives, such as loan forgiveness and increased salaries, are essential.
  • Support and train all unpaid caregivers – including family, friends and other caregivers. Much of the 37 billion hours of care in the U.S. is provided by the more than 40 million unpaid family caregivers. If they were paid, it would cost an estimated $470 billion.
  • An essential step in addressing our fragmented health and long-term care system is to adopt care models that provide well-coordinated, person-directed and family-focused services across settings.
  • Team based geriatric care is critical to providing high-quality care for older adults, many of whom have multiple complex chronic conditions. This requires a provider team with a diverse range of skills for addressing this population’s physical, mental, cognitive, and behavioral needs.

Ultimately, it is about transformational change in the workplace. AND the workplace Interdisciplinary Team Carewhere the bulk of care takes place is the patient’s home within a community. The system in place was not set up to provide extensive care in the home or community. As such, our current workforce provides care in a patch work manner.

We know how to do this. We have dozens of models of care that can work. However, we are moving too slowly. The number of older baby boomers is increasing at the same time the workforce and family caregivers providing care are decreasing.

As the daughter of a baby boomer, I worry about this from a personal perspective. How long will my parents be able to live in their log cabin in the woods? With several diagnosed chronic conditions already, are there professionals in their area adequately trained in the care of older adults? What if they need round the clock care? We have known about these issues for many years, yet we shy away from asking these questions until we reach a crisis. Well we are here, baby boomers are already turning 70. We have very little time to make this systematic change. We must reprioritize the care of our parents, grandparents, and ultimately us. We must demand it of our elected officials and communities.

Abby Marquand, PHI, and I explore these issues at greater length in the latest issue of Generations.


Amy York is the Executive Director of the Eldercare Workforce Alliance.