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ABSTRACT A looming question for policy makers is how growing diversity of the US elderly population and greater use of home and community-based services will affect demand for long-term care workers. We used national surveys to analyze current use and staffing of long-term care, project demand for long-term care services and workers through 2030, and assess how projections varied if we changed assumptions about utilization patterns. If current trends continue, the occupations anticipated to grow the most over the period are counselors and social workers (94 percent), community and social services workers (93 percent), and home health and personal care aides (88 percent). Alternative projections were computed for scenarios that assumed changing racial and ethnic patterns of long-term care use or shifts toward noninstitutional care. For instance, if Hispanics used services at the same rate as non-Hispanic blacks, the projected demand for longterm care workers would be 5 percent higher than if current trends continued. If 20 percent of nursing home care were shifted to home health services, total employment growth would be about 12 percent lower. Demographic and utilization changes would have little effect on projections of robust long-term care employment growth between now and 2030. Policy makers and educators should redouble efforts to create and sustainably fund programs to recruit, train, and retain long-term care workers.
By 2030 the number of Americans ages sixty-five years and older is projected to exceed seventy million, representing 20 percent of the population.1 In the first half of the twenty-first century, the number of older adults needing long-term care services is anticipated to more than double, from approximately eight million in 2000 to nineteen million by 2050.2 Currently, one-quarter of older adults who need long-term care services live in institutions such as nursing homes and other residential facilities; three-quarters of older adults requiring such services receive them at home and in other community-based settings.3
A number of national reports have raised concerns about the ability of the long-term care workforce to keep pace with the growth in the number of older adults who will require longterm care services in coming decades.4,5 The Institute of Medicine projected that the United States will need an additional 3.5 million longdoi: term care health care workers by 2030 simply to...