From the U.S. Government Accountability Office, www.gao.gov Transcript for: : Long Term Care Workforce Description: Audio interview by GAO staff with Kathleen King, Director, Health Care Related GAO Work: GAO-16-718: Long-Term Care Workforce: Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers Released: September 2016 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's September 2016. Millions of older Americans and people living with disabling conditions rely on long-term services and supports. Direct care workers can help those in need perform routine daily activities such as eating and bathing. A team led by Kathleen King, a director in GAO's Health Care team, recently reviewed information about direct care workers. Eden Savino sat down with Kathy to talk about what they found. [ Eden Savino: ] The phrase direct care worker is pretty broad. Who are these workers and what types of work did they actually do? [ Kathleen King: ] Well, they're people, all different kinds of people who have that title. And some of them include home health aides, psychiatric aides, nursing assistants, and personal care aides. But there also could be other names for people who do this work. And basically they help people who need help with activities of daily living. They need help with bathing or dressing or they need wound care and/or other types of personal assistance. [ Eden Savino: ] And these people can work sort of in someone's home and also in a facility? [ Kathleen King: ] Yes, they can. They can work in a nursing home. They can work in someone's home. They can work in an assisted living facility. [ Eden Savino: ] And what did you find out about how this workforce is changing? [ Kathleen King: ] Well, that's a good question because I think we don't know enough about this workforce because data are hard to come by. And that was one of the big things we found in our report is that HRSA, the Health Resources and Services Administration, which is responsible for healthcare workforce issues has not projected supply or demand of this workforce. And we think that's a really important thing to do. [ Eden Savino: ] And when you talk about supply and demand, people always talk about the baby boomer generation and how they're moving up in age and they've changed sort of everything they've touched. How is the baby boomer generation going to affect the direct care workforce? [ Kathleen King: ] Well, by 2030, baby boomers are going to be 20 percent of the population. So, they are growing at a much faster rate than younger generations. And the people who will take care of the baby boomers are not growing as quickly as the number of baby boomers. So, there's likely to be a mismatch between the people who need care and the people who are providing care. [ Eden Savino: ] You just mentioned that the Health Resources and Services Administration that does these projections, they don't necessarily have the data to really measure that mismatch between the people who are aging and the workforce. [ Kathleen King: ] Right. We know how many people are going to be over 65. And we know that population is growing. And we know the younger population. But we don't know exactly how many of those people are going to need care. [ Eden Savino: ] So what don't we know about the long-term care workforce? [ Kathleen King: ] Well, one of the things we really don't know is the rate of turnover or attrition. We piece together a lot of different data sources to do our work. And we came up with a pretty good and solid information about the size of the workforce and the wages, but we really don't have data on how quickly that workforce turns over and we think that's important information. The other thing that we don't know, which is really important is how many people are working in independent situations. In other words, your mother needs help and you hire the lady down the street to take care of her rather than you go through a state Medicaid program to hire someone who's on the books of the state Medicaid program and they do the payroll. [ Eden Savino: ] So, it sounds like there are some GAO recommendations then to the Health Resources and Services Administration related to projecting the needed workforce. Can you talk a bit about what you recommended to HRSA? [ Kathleen King: ] Yes. I mean, we think that projecting supply and demand is difficult. But we think it's very important. And we know there are data limitations, but we recommend that HRSA take some steps to overcome some of those data limitations so that they can do the projections. [ Eden Savino: ] So, what would you say is the bottom line of this report? [ Kathleen King: ] We need to know more about the long-term care workforce and we need to know more about how many of them there will be and what the need will be for them particularly as the baby boom generation ages. [ Background Music ] [Narrator:] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.