PHI Issues Research Brief Entitled 'The Direct Services Workforce In Long-Term Services and Supports in Maryland and the District of Columbia'

WASHINGTON, May 3 -- PHI has issued a 32-page research brief entitled: "The Direct Services Workforce In Long-Term Services and Supports in Maryland and the District Of Columbia".

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Known as "America in Miniature" for its diverse natural terrain, Maryland is also a microcosm of the United States when it comes to population change and the growing crisis in care for older adults and individuals with disabilities. Within the next decade, the number of adults aged 65 and older in Maryland and its urban neighbor, the District of Columbia (DC), is expected to increase by more than 330,000 (a 36 percent increase from 2015 to 2025), while the population of working-age adults will increase by less than 80,000 (just 2 percent)./1

Mirroring national realities, these trends contribute to a growing mismatch between the population demand for long-term services and supports (LTSS) and the supply of direct services workers who provide them. The poor quality of direct services jobs exacerbates this workforce shortage, as workers move to other sectors that offer better wages and benefits, more stable hours, opportunities for advancement, and other advantages./2

Providers, payers, policymakers, and other stakeholders in Maryland and DC agree that improving direct services jobs and the stability of the workforce is a pressing priority. To help inform efforts to improve recruitment, retention, and career development, this research brief provides a detailed snapshot of LTSS needs and the direct services workforce across this diverse region. By taking a collaborative, data-driven approach, Maryland and DC can lead the nation in addressing these challenges and ensuring that older adults and people with disabilities access the care and support they need in the years ahead.

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METHODOLOGY

The analyses in this report include personal care aides, home health aides, and nursing assistants, which are the three primary occupational categories for direct services workers according to the Standard Occupational Classification (SOC) system developed by the Bureau of Labor Statistics (BLS). The North American Industry Classification System (NAICS) was used to define long-term care industries, including home care (Home Health Care Services and Services for the Elderly and People with Disabilities); nursing homes (Skilled Nursing Facilities only); and residential care (Residential Intellectual and Developmental Disability Facilities, Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly, and Other Residential Care Facilities)./3

Wages, employment trends, and employment projections were sourced from the BLS Occupational Employment Statistics (OES) program, the BLS Employment Projections program, and the Maryland Department of Labor, Licensing, and Regulation's Office of Workforce Information and Performance (OWIP). Wages were calculated as a weighted average of median hourly wages by occupation in each region. (Small survey samples at the local level impede cross-tabulations of wage and employment data by industry and occupation.) Median wages are preferable to mean wages, which are skewed by a small proportion of atypically highly paid home care workers. The Consumer Price Index (CPI) for All Urban Consumers (Current Series) was used to adjust wages for inflation.

Direct services worker demographics, employment status, annual earnings, poverty status, reliance on public assistance, and health insurance status were analyzed from the U.S. Census Bureau's American Community Survey (ACS). Given the imprecise coding system used by the ACS, two parent industries--Individual and Family Services and Residential Care Facilities (Except Skilled Nursing Facilities)--were used to examine home care workers and residential care workers.

To achieve as much specificity as possible about workforce supply and demand in Maryland while accounting for smaller sample sizes in some areas of the state, this report developed regional definitions using elements of metropolitan and nonmetropolitan statistical areas (as defined by the U.S. Census Bureau) combined with Workforce Investment Areas (as defined by the Maryland Department of Labor, Licensing, and Regulation). Because county-specific data are not available through the American Community Survey, Public Use Microdata Areas (PUMAs) were converted to counties and then classified into regions to align with the other analyses in this report.

Link to map below.

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KEY FINDINGS

1. The population in the Maryland and DC region is rapidly growing older, which is driving up demand for long-term services and supports (LTSS).

2. From 2014 to 2024, Maryland will need nearly 40 percent more direct services workers and DC will need 35 percent more workers to meet growing LTSS needs.

3. The majority of direct services workers in the region are women (88 percent) and people of color (88 percent), and 32 percent were born outside the U.S. The demographic profile of the workforce varies significantly across the region, particularly between rural and urban areas.

4. Direct services workers in Maryland earn a median hourly wage of $13.03 and median annual income of $22,700, while those in DC earn $14.19 per hour and $23,700 per year. Earnings vary from $14,600 for some workers on the Eastern Shore to nearly $28,000 in DC.

5. Nearly 1 in 5 direct services workers in DC and more than 1 in 10 in Maryland live in poverty. Sixty-three percent of workers in DC and 43 percent in Maryland rely on some form of public assistance.

6. Nearly 50 percent of the direct services workforce have not completed formal education beyond high school, though educational attainment rates range from about 40 percent to nearly 60 percent across the region.

7. At least 1 in 10 direct services workers in Maryland (16 percent) and DC (10 percent) lacks health insurance. In some parts of the region, more than a third of the workforce with health insurance relies on Medicaid, Medicare, or another form of public coverage.

8. Transportation needs vary across the region: most workers in Maryland rely on private cars to get to work (72 percent), while nearly half of workers in DC (46 percent) use public transportation.

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Footnotes:

1/ Maryland Department of Planning State Data Center. 2017. Household Population Projections by Age, Sex and Race. http://planning.maryland.gov/ MSDC/Pages/s3_projection.aspx; DC: District of Columbia Office of Planning. 2016. DC Forecasts, Population Forecast by Single Age Citywide. https://planning.dc.gov/node/1212966; analysis by PHI (July 14, 2018). "Working age" includes those aged 20 to 64 years old.

2/ Espinoza, Robert. 2017. 8 Signs the Shortage in Paid Caregivers is Getting Worse. Bronx, NY: PHI. https://phinational.org/wp-content/uploads/2017/11/ workforce-shortages-phi60issues01.pdf.

3/ PCAs and HHAs in the nursing home industry were included in the residential care industry. These workers are likely supporting residents of Assisted Living Facilities and Continuing Care Retirement Communities that offer nursing services.

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The full research brief, including map, can be viewed at: https://phinational.org/wp-content/uploads/2018/09/DSWorkers-Maryland-2018-PHI.pdf

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