Trends In Home Care Versus Nursing Home Workforce Sizes

Are States Converging Or Diverging Over Time?

Published in: Health Affairs, Volume 40, No. 12, pages 1875-1882 (December 2021). doi: 10.1377/hlthaff.2021.00749

Posted on RAND.org on February 08, 2022

by Esther M. Friedman, Bonnie Ghosh-Dastidar, Teague Ruder, Daniel Siconolfi, Regina A. Shih

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There is strong preference among people with disabling conditions to receive care at home rather than in an institutional setting. Differences in state policies may make this more feasible in some states than others. Yet no study to date has examined trends in the long-term care workforce across states. Using state-level data on direct care workers from the period 2009–20, we examine trends in the sizes of the nursing home and home care workforces. We show that since 2009 most states have increased the size of their home care workforces and decreased the size of their nursing home workforces, but there is substantial variation across states in the magnitude of these changes. In addition, the gap between leading and lagging states in home care workforce size has grown over time. This suggests that more targeted efforts may be needed to ensure that people with disabling conditions can have their needs met in their desired setting across the nation.

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