For example, direct care workers as a  group are also referred to as paraprofessional workers, direct support  professionals, or direct service workers. Federal Data Provide Broad Picture of the Direct Care Workforce but Contain Limitations and Gaps; Some States Have Collected Data in These Areas

		Federal Data on the Number, Characteristics, and Compensation of Direct Care Workers Exist but Have Limitations, and Data about Workforce Stability Are Unavailable

Federal data from the Census Bureau’s ACS show that in 2014, the direct  care workforce that provided LTSS totaled an estimated 3.27 million  workers, about 20 percent of the total U.S. health workforce that year. We were unable to identify federal data sources on workforce stability  measures, which are often used for workforce planning. Some States Have Collected Detailed Data in Areas Where Federal Data Are Lacking

The four states we reviewed (Arkansas, Maine, Minnesota, and Oregon)  each conducted one-time studies to obtain more detailed information  about direct care workers who provide LTSS in those states. We obtained summary results from independent provider  surveys for Maine and Minnesota, which showed that most responding  independent providers worked for a family member, a neighbor, a friend,  or someone else they knew. HRSA Has Developed Some Information on the Direct Care Workforce but Has Not Projected Supply and Demand or Overcome Data Limitations

		HRSA Has Developed Some Information about the Direct Care Workforce

We identified two reports that HRSA issued in the last 12 years that have  provided information about the direct care workforce. Personal care aides and the occupational grouping titled  nursing, psychiatric, and home health aides were among the 35  occupations included in this report. HRSA Has Not Produced Projections of Supply and Demand for the Direct Care Workforce or Developed Methods to Address Data Limitations

HRSA’s strategic plan includes a goal to enhance focus on workforce  assessment and policy analysis through developing and employing  approaches to monitoring, forecasting, and meeting long-term health  workforce needs. According to HRSA’s website, the National Center for  Health Workforce Analysis conducts projections of the supply of and  demand for the U.S. health workforce and works to overcome inherent  data challenges in making these projections by improving available data;  HRSA has not yet done this for direct care workers. Conclusions

Direct care workers are responsible for providing the majority of paid  hands-on care to millions of elderly and individuals with disabilities  needing LTSS. However, reported high attrition rates and problems  recruiting and retaining these workers, along with the anticipated rise in  the elderly population, have fueled concerns about shortages. Unless  HRSA takes actions to overcome data limitations in order to make  projections of supply and demand, the ability of policymakers and other  stakeholders to develop appropriate workforce strategies to ensure a  sufficient number of qualified direct care workers will continue to be  hampered. Recommendation for Executive Action

To improve available data about the direct care workforce, we  recommend that the Acting Administrator of the Health Resources and  Services Administration  take steps to produce projections of direct care workforce supply and  demand and develop methods to address data limitations in order to  do so. In its comments, HHS concurred with our recommendation that HRSA  take steps to develop projections of direct care workforce supply and  demand, stating that developing such projections is timely and important. Congruent with the message of our report, HHS stated that given the  growth in the aging population and the challenges in recruiting and  retaining direct care workers, having clear information on this workforce is  critical for workforce planning. One limitation of the BLS surveys we reviewed is that the extent to which  they include direct care workers working as independent providers is  unclear. The data include information  on the percentage of direct care workers out of all health workers, and  direct care workers’ demographics, wages, hours, and benefits.
Why GAO Did This Study

Millions of elderly individuals and persons with disabling conditions rely on LTSS to help them perform routine daily activities, such as eating and bathing. Direct care workers are among the primary providers of LTSS. Reported difficulties recruiting and retaining direct care workers and the anticipated growth in the elderly population have fueled concerns about the capacity of the paid direct care workforce to meet the demand for LTSS. Despite these concerns, policymakers lack data to help assess the size of the problem.
GAO was asked to provide information on direct care workers who deliver LTSS. This report examines (1) federal and state data available on the paid direct care workforce and (2) actions HRSA has taken to develop information and projections on this workforce. GAO analyzed the most recent data available from the Census Bureau and Bureau of Labor Statistics on paid direct care workers' demographics, compensation, and benefits and reviewed efforts to collect data on direct care workers in four states, selected in part for geographic variation. GAO also reviewed HRSA documents and interviewed agency officials about HRSA's previous, ongoing, and planned efforts to improve data.

What GAO Found

Federal data sources provide a broad picture of direct care workers—nursing assistants and home health, psychiatric, and personal care aides—who provide long-term services and supports (LTSS), but limitations and gaps affect the data's usefulness for workforce planning. Some states have collected data in areas where federal data are limited, but these have been one-time studies. Federal data show that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 percent of the nation's health workforce. Federal data show that wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015. However it is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. The number of these workers, often referred to as independent providers, is believed to be significant and growing. Some states, in coordination with the federal government or on their own, have conducted studies about direct care workers and collected detailed information. These studies showed that a majority of independent providers worked for a family member or someone else they knew.
The Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), which is responsible for monitoring the supply of and demand for health professionals, has developed some information on direct care workers. However, HRSA has not produced projections of this workforce or developed methods to address data limitations, which is in line with one of the goals in its strategic plan. HRSA's actions include sponsoring research and issuing a 2013 report that summarized federal data on different occupations, including direct care workers. While HRSA has recognized the limitations of existing data and cites these as reasons it has not developed projections for this workforce, the agency has not developed methods to address data challenges. Unless HRSA takes steps to overcome data limitations in order to make projections of supply and demand for direct care workers, policymakers will continue to be hampered in their ability to identify workforce trends and develop appropriate strategies to help ensure a sufficient number of qualified direct care workers.

What GAO Recommends

GAO recommends that HRSA take steps to produce projections of direct care workforce supply and demand and develop methods to address data limitations in order to do so. HHS concurred with GAO's recommendation, stating that developing projections for the direct care workforce is timely and important.