Iowa Ideas
Iowa Ideas

To provide a nonpartisan, statewide learning experience

designed to explore the key questions and big ideas that will shape the future of Iowa.

Iowans' Ideas: Health and long-term care workforce shortages affect all - particularly rural Iowa

There are solutions possible, but we can't kick the can down the road

Jun 25, 2018 at 5:00 am
    (File photo) Rhonda Bernhardt, a volunteer nurse, hangs up a stethoscope after a patient intake session at His Hands Free Clinic on Wednesday, May 10, 2017. (Rebecca F. Miller/The Gazette)

    People are a lot like cars.

    Some are brand-new. Some have been around awhile. Some are showing their age.

    Both cars and people need a service infrastructure to keep them going and have the best “lives” possible.


    Cars need gas stations, repair shops, parts stores and the like. People need doctor’s offices, pharmacies, hospitals, nursing facilities, etc.

    That service infrastructure depends on having enough well-trained and dependable people to provide the services.

    Aging Iowans already feel the impact of a workforce crisis. There are not enough people in health and long-term care occupations to serve and support them.

    There are significant shortages in occupations such as geriatricians, geriatric psychiatrists, nurses, social workers, substance abuse and mental health workers, and direct care workers. While these shortages exist throughout Iowa, they are particularly severe in rural areas.

    And it’s only going to get worse.

    • There is an aging wave moving across Iowa. In a quarter of Iowa’s 99 counties, 20 percent or more of the population is age 65 and over. In the next decade or two, it’s estimated that will be the case in more than 80 percent of Iowa’s counties.

    • One of every four Iowans is a baby boomer — 750,000 people. They’re reaching the age where they’ll need more health and long-term care services.

    • One of the fastest growing segments of Iowa’s population is the oldest of the old — the age 85 and up category. A significant proportion of them live in rural Iowa.

    So we have, and will continue to have, more people who need services and assistance from health and long-term care occupations, and not enough people to provide them.

    The implications? The physical and mental health of older Iowans, particularly those in rural Iowa, suffers. For too many, quality of life is not what they want, or what it could and should be.

    What’s been done in Iowa to deal with the shortages in health and long-term care occupations? Not nearly enough.

    Consider “direct care” occupations. Direct care includes certified nurse aides, home care and home health aides, personal support attendants, patient care technicians and other such occupations. They work in nursing facilities, hospitals, assisted living centers, in private residences and other locations.

    Direct care is one of the largest and most in-demand occupations in the state. The most current estimates show that Iowa has approximately 61,000 individuals in direct care occupations, and that we’ll need 71,000 or more by 2024.

    Vacancies in direct care number in the thousands across Iowa. Employers, in many cases, cannot find people to fill the openings, or if they do, too many leave within the first few months because they find the work too difficult, and the pay, training and benefits inadequate.

    Shortages of direct care staff result in services being delayed, being denied or being of poor quality.

    For more than a decade — yes, a decade — leaders have studied, discussed, convened committees, commissioned reports and even held summit meetings to highlight the issues.

    They have described the challenges and identified solutions, including:

    • Giving this workforce the respect it deserves. Those who do this work possess skills and talents that need to be acknowledged and appreciated.

    • Paying those in direct care a livable wage and providing them a good benefits package.

    • Creating career ladders or specialty roles that enable workers to grow in the profession, learn more and perform better.

    Sadly, our leaders in state government have done little to implement them.

    An opportunity to do so came and went in March of this year. The Iowa Senate was debating the Future Ready Iowa bill designed to address workforce challenges in Iowa. An amendment was offered to add direct care occupations to the bill, to finally give this workforce the attention needed. The amendment was defeated. All Democratic senators voted for the amendment. All Republican senators, except one, voted against it.

    A Republican state legislator told me well over a year ago, “We know the Legislature needs to be dealing with these issues. We can’t continue to kick the can down the road.”

    If our elected leaders at the Iowa Statehouse decline to address these health and long-term care workforce issues, could it be time we kicked their cans down the road?

    ■ John Hale is co-owner of the Hale Group, an Ankeny-based consulting, advocacy and communications firm that encourages thought and action on aging and caregiving issues;


    About this story: Iowans’ Ideas is a new guest opinion series, speaking to the key issues of today and future for the state, as seen by one Iowan.

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