To address California’s significant shortage of healthcare workers for seniors and others, a major state health and human services department is supporting multiple new initiatives to significantly increase the home- and community-based services workforce.
A Critically Understaffed Healthcare Workforce
Regardless of their location, race, income or health status, older Americans overwhelmingly (nearly 90%) wish to stay in their current home and community as they age, as opposed to residing in an assisted living or skilled nursing facility. The challenge is providing these older adults with the care they need to age in place, safely, independently and comfortably. The solution for millions of seniors, as well as those with disabilities requiring care, is home- and community-based services (HCBS).
No state has more senior residents than California. By 2030, California’s senior population is expected to hit 10.8 million, or one-fourth of the state’s projected population by that time. Studies such as from Public Policy Institute of California (PPIC) suggest over 1 million of those seniors will need home health care. Additionally, there are more than 4.5 million disabled adults under age 65 in California, with at least 1.75 million requiring home-based health care.
The problem is that there is a severe healthcare workforce shortage of HCBS staff in California. A recent UCLA Labor Center report describes a caregiving industry “in crisis” and ill-prepared to meet demand.
To address California’s significant shortage of healthcare workers for seniors and others, a state healthcare department, at the direction of California’s governor, is supporting multiple new initiatives to significantly increase the HCBS healthcare workforce.
These initiatives seek to address a projected shortage of 440,000 certified nursing assistants (CNAs), home health aides (HHAs), licensed vocational nurses (LVNs) and registered nurses (RNs) between now and 2028, according to state labor market data.
Given the breadth and complexity of these initiatives, this department hired Freed Associates (Freed) to provide experienced healthcare consulting services to establish a workforce growth and retention strategic roadmap, analyze challenges and best practices and define success measures to assess program efficacy.
Closing the Healthcare Worker Shortage Gap
With a mandate to increase patient access to in-home health services, the department and Freed initially focused their landscape analysis and strategic planning work around three critical ways to increase the state’s HCBS workforce:
Increase the HCBS workforces serving medically underserved areas in the state
Increase the cultural and language diversity of the HCBS workforce
Increase the HCBS workforce serving Medi-Cal members
Reflective of California’s highly diverse population, there also needed to be a strong focus by this department on health equity – ensuring that every state resident has the opportunity to achieve their full health potential, regardless of socially determined circumstances.
Workforce Recruitment and Retention Strategies
Across California, all types of healthcare organizations are experiencing staffing shortages, and requiring help with recruitment, retention and training. In particular, the CNA and HHA workforce has been dwindling due to commonly seen factors such as stress, insufficient wages and benefits (especially compared with other similar level roles), and the inherent physical and mental toll of the job. These healthcare professionals’ roles are crucial, yet not widely known, nor is there an established career path that enables professional and income growth.
Thus, with client input, Freed coordinated across multiple stakeholder groups and developed a series of HCBS recruitment and retention recommendations, and a healthcare workforce supply and demand measurement roadmap, designating desired goals. In conjunction, Freed also developed a series of standard quantitative and qualitative measures for each HCBS recommendation, to enable the client (and other interested parties) to assess progress against each of the client’s stated goals.
Ultimately, Freed identified nine strategies within five key themes to support individuals and organizations involved in the HCBS career path, and addressed processes and data gaps and needs:
Student/employee financial and career support – Provide potential and current HCBS workers in the state with access to employment or training opportunities, and financial and mentoring support to pursue such opportunities. Design and offer continuing education modules and career paths.
Instructor and training program support – Offer faculty and training program administration with financial support and coaching to turn around staffing shortages and build sustainable recruitment, retention and training programs. Encourage retired or experienced HCBS staff members to engage through mentorship or teaching. Teach employers how to implement and sustain continuing education, which serves as a recruiting base.
Diversity, equity, and inclusion – Recruit for diversity, offer equitable support and design inclusive settings not just for students and employees, but also for instructors, schools, and employers.
Workforce data and analytics – Address the data and analytic gaps around HCBS workforce supply and demand including socioeconomic, language and racial factors.
Public outreach and education – Raise awareness and engage potential workforce via multiple communications channels on the value of HCBS roles and available opportunities for training, employment and career growth.
Five Key Themes to Invigorate and Expand the HCBS Clinical Workforce
Partnerships and Collaborations with the Caregiver Industry
Through ongoing iterative discussions, the client and Freed formed trusted relationships with more than 27 key industry partners and sister departments to support and potentially partner with this department on its HCBS initiatives. This was critical to start engaging with the caregiver industry and paving the way to iteratively collaborate for growing the HCBS workforce.
Metrics and Dashboards to Measure Progress
Freed also helped the department develop an operating model to measure the success of the department’s initiatives across multiple measures, including around diversity, equity and inclusion (DEI) metrics. The latter is particularly vital as more than half (53%) of CNAs are people of color. With new key performance indicator (KPI) dashboards created and embedded with the department’s project team, the department now has the ability to properly assess and oversee progress of its HCBS initiatives against its newly established KPIs.
By addressing California’s caregiver shortage holistically and comprehensively, the department is on its way to better serving our senior and disabled Californians with caregiver capacity and workforce opportunities for California residents. The department now has a strong pipeline of potential programs and partners to grow the HCBS workforce.
In addition, the department has a series of strategic roadmaps around data and analytics, communications and industry/agency partnerships to prioritize its work and meet its HCBS goals. This foundation will be critical to enable the department to track its impact on healthcare workforce trends over time, enable ongoing monitoring and reporting of program successes, and test and learn about current strategies to inform future state investments in HCBS development.
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