The impact of health care reform on the workforce caring for older adults.

This article summarizes the Patient Protection and Affordable Care Act (ACA) provisions that have a direct or indirect impact on the workforce caring for the elder population, explores the challenges to developing the workforce, and critiques the adequacy of the ACA provisions in meeting those challenges. The ACA is the first comprehensive federal legislation to acknowledge gaps in the workforce caring for the elder population. However, its provisions are inadequate given insufficient supply in the number and types of workers necessary both to meet the caregiving demand of the growing elder population and to implement the delivery system reforms instituted by the ACA. One of the challenges is that the workforce is not prepared for the new service delivery models specified in the legislation. They are not trained, supported, or held accountable for effective care coordination and service integration, and they lack the requisite skills, knowledge, and competencies. Moreover, it is likely to remain difficult to recruit and retain competent direct care workers, who represent the largest component of the long-term care workforce, because of the negative industry image, noncompetitive wages and benefits, a challenging work environment, and inadequate education and training. Several of the ACA provisions for developing the workforce have not received appropriations. Most are also demonstration projects of limited scope and duration.