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12 Ways to Strengthen the LTSS Workforce

by Dr. Robyn I. Stone

During National Workforce Development Month, let’s all take definitive action to strengthen the LTSS workforce.

Now that Labor Day has come and gone, we’re heading into a 30-day celebration of workers called National Workforce Development Month.

Both of these annual celebrations give providers of aging services myriad opportunities to acknowledge and honor the people who deliver and manage the high-quality long-term services and supports (LTSS) that nonprofit organizations around the nation deliver to older adults.

I’m all for taking advantage of any opportunity to show appreciation to LTSS workers. But, this year I challenge providers to move beyond accolades. Let’s take definitive action, and urge others to take definitive action, to strengthen the LTSS workforce.

Consider these 12 ideas.


#1 Tie Medicare/Medicaid reimbursement directly to workforce development.

It’s time for providers in every state to remind policy makers that programs like Medicare and Medicaid actually pay the salaries of LTSS workers, in addition to funding the care interventions these workers deliver. Policy makers know this, or course. But the message bears repeating: LTSS providers need healthy reimbursement rates so they can attract and support a competent workforce.

#2 Include workforce indicators in quality measures.

Quality measures rightfully focus on the care residents receive. But these measures also need to guage the quality of our workplaces. Measuring turnover, retention, and workforce practices can tell us a great deal about the undeniable relationship between a quality workforce and quality care.

#3 Support investment in LTSS jobs in communities experiencing worker shortages.

The Centers for Medicare and Medicaid Services (CMS) has long recognized that “rural areas face unique direct service workforce challenges that require unique solutions.” One creative solution would use public dollars to offer incentives to high-quality caregivers and managers who agree to re-locate to rural communities that have large populations of elders and serious worker shortages.

#4 Incorporate competency requirements into new models of care.

It makes no sense to design new models of care without paying attention to the skills frontline caregivers and managers will need to implement those models. It’s time we all recognized that even the most innovative care model will not succeed without a robust and well-trained workforce.

#5 Explore and expand opportunities for nurse delegation.

We could revolutionize our LTSS care settings if more states allowed nurses to delegate certain tasks to other team members working under their close supervision. This includes certified nursing assistants and home health/home care aides. Nurse delegation empowers direct care workers, elevates their position in the care setting, and bolsters recruitment and retention—all while saving health care dollars.


#6 Develop faculty and curricula for the LTSS sector.

For too long, we’ve trained LTSS managers and caregivers using curricula that simply borrow principles and approaches from the acute and primary care sectors. It’s time to develop more targeted training materials that address the unique nature of the LTSS field. We also need to recruit more educators with the LTSS expertise necessary to deliver this training effectively.

#7 Offer quality clinical and management placements.

The best way to attract high-quality clinicians and managers to LTSS organizations is to offer them meaningful opportunities, while they are still in school, to experience what it’s like to work in our field. I urge providers to reach out to educational partners and invest the time and money needed to develop meaningful placements designed to attract committed, long-term employees.

#8 Expand apprenticeship programs.

Apprenticeships represent a wonderful and woefully unappreciated way to bring talented people into our field by allowing them to “learn and earn.” By sponsoring an apprenticeship  program, you send a message to prospective employees that you’re willing to invest in their future. I can’t think of a better way to train workers on the job while fostering their long-term loyalty.


#9 Become and employer of choice.

Being an employer of choice means that you pay as much attention to the quality of your workplace as you do to the quality of the care provided there. Follow that path, and news about your workplace culture will surely travel quickly throughout worker networks.

#10 Develop innovative career ladders and lattices.

No one will stay in a “dead-end” job for long. That’s why it’s vital to create opportunities for all staff, including frontline aides, to advance in their careers. Be creative about career ladders and lattices. Offer opportunities to pursue a specialty, in such areas as dementia care or medication management, to aides who don’t want to become nurses. Remember that advancement opportunities can come from unexpected places. For example, a peer mentorship program that helps new team members feel at home in your organization can also build management skills—and pave the way to future management positions—for program mentors.

#11 Support quality training.

Use evidence-based programs to train managers and frontline team members. Develop in-service training for current managers who never had formal management training. Work with local academic institutions to ensure that their programs are training new frontline caregivers and managers you’d be proud to add to your team. Back up all training with meaningful opportunities for caregivers and managers to put what they learned into practice.

#12 Redesign jobs to accommodate older workers and millennials.

It takes people of all ages to make an organization work. Participate in programs dedicated to helping older and displaced workers find new careers after retirement or a layoff. Take steps to ensure that the older workers on your team have good reasons to stay. And don’t forget about millennial workers. You’ll need to take deliberate steps to accommodate their unique work preferences and take advantage of their equally unique gifts.


Will these 12 steps solve our workforce crisis? Not likely. Is each step easily achievable? Not on your life.

But we need to start somewhere.

These steps offer us a few avenues to explore. And National Workforce Development Month seems like a good time to begin.

Robyn I. Stone

Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.