#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.


Geriatric Training for the Workforce and Community

With U.S. demographics shifting, an increasing number older adults will require care as they age.  In an effort to develop a well trained workforce to care for our seniors, U.S. Health Resources and Services Administration (HRSA) developed the Geriatrics Workforce Enhancement Program (GWEP).  This important grant allows health and education institutions to develop programs that are responsive to specific interprofessional geriatrics education and training needs of their communities.  In July 2015, HRSA awarded 44 grants in 29 states including a 3-year $2.45 M grant to Rush University Medical Center (RUMC) in Chicago, Illinois.

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As part of its efforts, RUMC is partnering with health care providers, universities and community organizations across the state. The 34 state-wide collaborators and partners have decades of experience educating patients, families, students, and professionals in innovative programs and strategies to care for older adults, particularly those with multiple chronic conditions, including Alzheimer’s Disease and Related Dementias (ADRD). They are positioned to bring change to the geriatric workforce in the state of Illinois, upper Midwest region, and nation.

The RUMC program, CATCH-ON, which stands for Collaborative Action Team training for Community Health – Older adult Network, is led by Robyn Golden, LCSW, and Erin Emery-Tiburcio, PhD.   The team is using the grant to (1) educate older adults, their families and caregivers, students, direct care workers and health professionals about the care of persons with multiple chronic conditions (MCC) with special attention to those with Alzheimer’s disease and Related Dementias (ADRD), and (2) transform primary care to better meet the needs of older adults.  The CATCH-ON team outlines their current projects as they relate to each goal.

Goal 1: Education

CATCH-ON is currently developing online learning activities about normal aging, managing multiple chronic conditions including Alzheimer’s disease and Related Dementias (ADRD) and working in teams for both professionals/students, and for lay learner audiences. Educating every member of the team using similar language will enhance communication among all involved. Building on the learning activities, the CATCH-ON team will develop training support, faculty development and course materials to expand geriatric content in academic programs, and state-wide Learning Communities to further the application of the learning activities.

CATCH-ON members are also developing a Health Ambassadors program involving diverse members of the community who may not typically play a role in direct health care delivery but are uniquely positioned to do so. Health Ambassadors will be community members who participate in the online learning activities and agree to apply that training in MCC/ADRD prevention and management with their family members, clients, and/or in their communities, and have the opportunity to participate in Learning Communities.


Goal 2: Primary Care Transformation

CATCH-ON team members have developed a Readiness Assessment instrument to assess and improve readiness of five partner clinics (3 urban, 2 rural) for practice transformation and identifying desired CATCH-ON Community Health elements. RUMC’s four evidence-based, patient-centered, interdisciplinary MCC management programs along with self-management programs form the foundation of CATCH-ON Community Health. The four programs included are: BRIGHTEN (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking), Bridge, AIMS (Ambulatory Integration of the Medical and Social), and ACT (Activation and Coordination Team).  The clinic and CATCH-ON teams will collaborate in identifying desired evidence-based practice-redesign elements; determine which components are best suited for infusion into existing clinic and community provider protocols; and customize CATCH-ON Community Health to the cultural and other specific needs of their locale. The team will then provide training and implementation support for CATCH-ON Community Health.

“We thank HRSA for the opportunity to build Illinois’s capacity to care for older adults through developing the eldercare workforce and new models of care that span the continuum of hospital, community clinic, community based agencies and home,” said Robyn Golden, who is director of Health and Aging at RUMC and Project Director of the GWEP.

For more information or to learn more, please visit www.catch-on.org or email  CATCH-ON@rush.edu to sign-up for their quarterly newsletter.


Michelle Newman, MPH
Health and Aging, Coordinator of Interprofessional Program Development
Rush University Medical Center
Johnston R. Bowman Health Center
EWA National Issue Brief
EWA Illinois Issue Brief
Medicare Beneficiaries with Multiple Chronic Conditions 



VA Medical Foster Home – Where Heroes Meet Angels

Elderly Veterans and Veterans who require around the clock care have numerous options available to them through the Department of Veterans Affairs (VA). Annually, thousands of Veterans turn to VA for care, whether it in a community residential care center, adult family home, community living center or a community nursing home partner.


For Veterans and older Americans in general, many want to remain at home as they age and their care needs increase. The VA Medical Foster Home provides an option to receive personalized care in the comfort of a home setting. The VA provides home medical care through their Home Based Primary Care (HBPC) team, which includes a medical provider, nurse, social worker, dietitian, rehabilitation and recreation therapist, as well as a mental health provider.   The Veteran utilizes their VA benefits to cover the costs of care in the MFH, which includes everything from meals to personal care to socialization. However, it is so much more than that. Since the MFH Caregiver must reside in the home, the Veteran becomes part of the family. Many Veterans go on outings, family gatherings, trips and vacations with their MFH families. They share in the celebrations.

Mr. Sawyer* is a Vietnam Veteran that chose to receive care at a MFH. When he returned from Vietnam, Mr. Sawyer suffered from PTSD, schizophrenia, and substance abuse. Most of his adult life he spent on the street or in jail, having multiple arrests for burglary and petty theft trying to get enough money to just survive. He was malnourished, isolated, and afraid. During his last trip to the County Jail he met with the VA Justice Outreach Social Worker who gave him another option, a chance for a new life.

IMG_3864-300x200Mr. Sawyer was provided with a four-poster bed in a warm Medical Foster Home (MFH). The medical team helped him access his VA benefits, pensions and other entitlements. They followed his medical conditions and ensured he was fed good home cooked meals, provided the right medications daily, socialized with other Veterans, and treated with dignity and compassion. Mr. Sawyer became a contributing member of society. He never went back to jail. He gained 40 pounds and smiled every day. As he neared the end of his life, he chose to die under Hospice care in his new home – his MFH – with his caregiver.

Ethel Gordon is one such caregiver. Originally from Trinidad, she grew up with a family who provided care to homeless in her own country. After a career in Mental and Behavioral Health and raising her children, she wanted to be able to work from home. After learning of the VA Medical Foster Home program, Ethel decided to bring 3 Veterans into her home and family. All have their own individual stories which include some mental health history.

“We all went to Florida together for vacation,” Ethel told me. “We go to church every Sunday. I was able to give them stability. There is always something going on.”

Her family is also involved, with her college-age children coming home on breaks and bringing home friends. “The Veterans all feel like they are back in college again,” Ethel shared. She says the joy it brings to her is much more than what she ever expected.

VA Medical Foster Home is the environment where our Heroes meet the Angels willing to open their individual homes to provide an alternative to institutional care. We salute them.

The MFH program began as a successful pilot at the Little Rock VA Medical Center in 1999 and has grown to include programs in 45 states and Puerto Rico. More than 3,500 Veterans have received care in a MFH since the inception.  

Dayna Cooper, RN, MSN
Director, Home and Community Care
Geriatrics and Extended Care Operations
US Department of Veterans Affairs

Read more about Ethel Gordon.

Learn more about EWA’s Support of the Medical Foster Home Program

 *name changed to protect identity


Welcome to the EWA Blog

Today, the Eldercare Workforce Alliance is excited to announce the launch of a new feature – the EWA Blog!

As a coalition of 31 national organizations joined together to address the immediate and future workforce crisis in caring for an aging America, this blog will serve as a platform for sharing the workforce perspective on critical issues happening in Washington DC and around the country.

Currently, a combination of demographic forces is causing an aging of American society. However, the current health care workforce is not large enough to meet older patients’ needs and the scarcity of workers specializing in the care of older adults – the eldercare workforce – is even more pronounced. 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.

Thanks to initial support and continued backing from the John A. Hartford Foundation, the new EWA blog will bring together members of our coalition, professionals, workers in the field, and experts in aging to raise awareness about these critical topics and provide practical solutions for moving forward.

Each month, the blog will feature a compelling and timely piece that highlights the state of our eldercare workforce, interesting policies and programs happening in the US, and personal stories from those in the field. We aim to share expert and everyday perspectives on a range of issues that impact our workers and those they care for, with the ultimate goal of stimulating discussion and influencing policy change.

The blog will feature inside perspectives on cutting edge research and reports, stories from those out in the field every day, and outlooks on what is, can, and should be done across the country to address important needs. Looking ahead at 2016, we already anticipate several important topics making an appearance on the site:

  • With Presidential and Congressional elections coming this fall, we will highlight where candidates stand and work to raise the profile of eldercare workforce issues in national policy debates.
  • New reports on chronic care, caregiving, and the geriatric workforce will provide information that enhance our understanding of the current eldercare workforce landscape and what we as a community can do to satisfy unmet needs.
  • We will also focus on innovative Veterans Affairs programs that garner important data and outcomes for future development of successful models to improve the care for the wider aging population.
  • Finally, EWA will highlight the work – big and small – being done by our coalition members, federal partners, and industry experts who work tirelessly to effect positive change across the workforce continuum.

We hope you will join the conversation by visiting each month and engaging in discussions around these critical issues.

We look forward to sharing the eldercare workforce perspective with you this year, and for years to come.

-Nancy E. Lundebjerg & Dr. Michèle J. Saunders, Alliance Co-Conveners


Coming Soon

The new EWA Blog is coming soon! Stay tuned!