strong workforce
Engage Magazine Winter 2021

LTSS Workforce: Can We Use 2020’s Challenges to Build a Better Future?


The year 2020 will go down in history as one of the more turbulent that our nation—and the field of long-term services and supports (LTSS)—has experienced. Chief among our challenges, of course, was the coronavirus pandemic that began sweeping the country early in the year.

LTSS Center UMass Boston LeadingAgeTragically, the pandemic targeted vulnerable older adults in nursing homes, assisted living communities, congregate settings, and private homes. It also had a significant impact on the direct care professionals who provide the vast majority of hands-on care in those settings. 

A few statistics clearly illustrate COVID-19’s impact on this LTSS workforce. The number of home care aides dropped by 232,000 during the first three months of the health crisis, while the number of aides working in residential care settings dropped by 50,000. Aides leaving the field were more likely to be healthy, younger, and white, according to research by the LeadingAge LTSS Center @UMass Boston. Those who stayed on the job represented populations already at heightened risk for contracting and transmitting COVID-19: workers aged 55 and older, or who are African American or Latinx. 

While Americans spent the year fighting COVID-19, we also found ourselves focusing anew on the longstanding racial and socioeconomic inequality that exists within our nation. Protest demonstrations following the death of George Floyd on May 25 spurred a national conversation about policies and practices that promote disparities across our society, and about strategies and solutions needed to help repair our divisions.

LeadingAge has launched initiatives to respond to both of these challenges. Many of our activities were designed specifically to help LeadingAge members strengthen their organizations by strengthening their workforces.

Workforce Challenges During the Pandemic

When COVID-19 became a global threat in February 2020, LeadingAge National quickly shifted its primary focus to the coronavirus and its effect on members. While working to provide daily support to members struggling to navigate the pandemic, we also began developing practical resources to help members recruit, retain, and support the LTSS workforce during the crisis.

One of those resources—an online “Pandemic Playbook”—includes pandemic-related resources, best practices, research, and lessons learned by members as they worked to mitigate the effects of COVID-19. The playbook’s workforce management and support section includes strategies that LeadingAge member communities used to recruit and retain staff, update staff policies, train team members, and tackle other essential issues. 

Existing LeadingAge workforce resources also gained new relevance during the pandemic. For example, a Recruitment Tools section on the Center for Workforce Solutions provides guidance on how LTSS providers might reach out to non-traditional populations, including displaced workers, when recruiting new team members. This information was particularly useful during the pandemic, when member communities found themselves seeking new workers at a time when workers in the hospitality, retail, and restaurant industries were losing their jobs.

Studying the Impact of COVID-19 on Direct Care Workers

During the pandemic’s early days, the LTSS Center partnered with WeCareConnectTM to study the impact of COVID-19 on LTSS direct care staff working for LeadingAge provider members. WeCareConnectTM, an employee engagement and management system created by Wellspring Lutheran Services, helps 165 organizations in more than 1,200 locations solicit regular feedback from their employees and facilitate continuous quality improvement. 

During May 2020, WeCareConnectTM added several questions, created by LTSS Center researchers, to its employee interview battery. An analysis of the responses to those questions showed that a substantial percentage of direct care workers experienced a host of challenges during the COVID-19 pandemic. 

Researchers found that direct care workers at nursing homes and assisted living communities faced increased workload demands and experienced understaffing more often than workers in home and community-based settings. Resigned employees experienced external and work-related challenges more frequently and reported higher levels of COVID-related stress than current employees. Current workers gave high marks to their organizations for preparing them for the pandemic and communicating with them during the crisis.

A forthcoming research report suggests that providers can help mitigate worker stress by offering workers wrap-around services, mental well-being support, and flexible and creative work schedules to reduce under-staffing and high workloads.

Diversity, Equity, and Inclusion

LeadingAge is embarking on a major initiative, called for in our strategic plan, to help members achieve greater diversity, equity, and inclusion (DEI) in their organizations. We believe that striving for DEI in all facets of our organizations is the right thing to do. We also know that the more diverse our organizations are, the more successful they will be in carrying out their missions. 

As a jumping off point for future action, LeadingAge surveyed multisite organizations and life plan communities to gauge their current reality and practices with respect to DEI. We are also conducting a literature review to learn more about the business case for diversity among mid-level managers and senior leaders, and to identify strategies for improving racial diversity in leadership. We will use these findings to begin charting a strategy for developing resources and supports for LeadingAge members striving to make their organizations more inclusive. 

As part of our effort to promote diversity, equity, and inclusion, LeadingAge launched the 10-week Summer Enrichment Program to help students of color gain exposure to our field. Beginning this summer, LeadingAge member communities participating in the program will offer a diverse group of students the opportunity to gain experience in our field, work with mentors, and take part in professional development, networking, and training events.

LeadingAge is also exploring a partnership with the United Negro College Fund (UNCF) to bring greater diversity to management and executive LTSS positions. UNCF has strong relationships with Historically Black Colleges and Universities, a longstanding record of intern placement, and experience training students and mentors.


The events of 2020 left an indelible mark on societies worldwide, and has spurred providers of aging services across the continuum to become nimbler and more creative around workforce solutions. LeadingAge pledges to continue supporting member organizations in these efforts by leading and learning from those organizations as we work together to build a stronger and more diverse workforce. 


Susan Hildebrandt, Vice President of Workforce Initiatives, LeadingAge

Robyn Stone, Senior Vice President, Research and Co-Director, LeadingAge LTSS Center @UMass Boston

Natasha Bryant, Managing Director/Senior Research Associate, LeadingAge