Here’s the latest in PHI’s Long-Term Care Expert Interview Series spotlighting issues and trends affecting direct-care workers.

When Josh Wiener talks, people listen. So it’s good news for everyone who’s working to improve direct-care jobs that Wiener talks a lot about the looming shortage of direct-care workers. The growing care gap, he says, is ”the elephant in the room” whenever people are talking about providing or reforming long-term care in the U.S.

Wiener, who got his bachelor’s degree from the University of Chicago and his masters and doctorate degrees at Harvard, all in sociology, has worked for the Health Care Financing Administration, the Urban Institute, and the Brookings Institution, among other influential institutions. He is currently a senior fellow and the program director for aging, disability and long-term care at RTI International. The author of eight books and more than 100 articles about long-term care, Medicaid, health reform, and related topics, he often advises state and federal policymakers on issues concerning aging, disability, and long-term care. In a recent interview with PHI, he explained why he has been warning those policymakers that they need to pay more heed to the growing care gap and how to close it.

The problem

”It seems to me that a lot of the discussions about improving the quality of care or changing the delivery system start with the assumption that we will have workers who can provide services, and I think the long-range demographics are such that that’s not clear at all,” he says. ”In 2005 there will be close to 35 people aged 25 to 64 for every person aged 85 and older, but by 2050 that ratio falls to about 15. So we’re going to have to get a much higher proportion of the overall workforce into long-term care than we are now, and given the pay, the benefits, and the overall structure of the job, we’re not very likely to be able to do that.

”That raises a lot of questions. Are we not going to provide the services? Are we going to put the old people on the ice floe and send them off? Are we going to find some kind of technological substitute? While I’m not quite as skeptical about the future of technology in this area as I was in the past, long-term care is basically a hands-on, person-to-person kind of job, and it’s not clear how technology is going to significantly substitute for people.” Continue Reading