Tracking long-term services and supports rebalancing through workforce data

Area of Science:

• Gerontology
• Health Services Research
• Public Health Policy

Background:

• Long-term services and supports (LTSS) are crucial for aging populations and individuals with disabilities.
• Understanding workforce trends is key to assessing the shift from institutional to community-based care.
• Existing methods for tracking LTSS rebalancing face challenges with data comparability.

Purpose of the Study:

• To analyze long-term services and supports (LTSS) workforce trends from 2008 to 2022.
• To evaluate the utility of LTSS workforce data as a measure of progress in shifting resources to community-based settings.
• To compare workforce supply measures with LTSS utilization and spending data.

Main Methods:

• Utilized American Community Survey data from 2008 to 2022, encompassing over 336,000 LTSS workers and 3 million individuals with LTSS needs.
• Constructed measures of LTSS rebalancing and workforce supply per capita.
• Employed state fixed effects regressions to analyze the relationship between workforce supply and LTSS utilization.

Main Results:

• The proportion of the LTSS workforce in community settings increased from 44% to 58% between 2008 and 2022.
• The community workforce grew substantially until 2013, then stagnated, while the institutional workforce declined, accelerating during the COVID-19 pandemic.
• Workforce supply measures strongly correlated with LTSS utilization for older adults but not for younger individuals with disabilities.

Conclusions:

• LTSS workforce data effectively tracks utilization changes for older adults, providing a comparable alternative to administrative claims.
• This approach bypasses comparability issues arising from coding changes and managed care shifts.
• Further research is needed on workforce trends for younger LTSS consumers.