UCSF to Fill Research Shortage on Long Term Care Workforce

The University of California-San Francisco has established a new research center tasked with examining hot topics related to the healthcare workforce, including training requirements and future demand for long-term care workers. 

UC San Francisco was awarded one of three Cooperative Agreements from the U.S. Bureau of Health Professions to establish the UCSF Health Workforce Research Center (HWRC), directed by Joanne Spetz, PhD, professor of economics at the UCSF Philip R. Lee Institute for Health Policy Studies in the Department of Family and Community Medicine and associate director of research strategy at the UCSF Center for the Health Professions.

“The aging of the U.S. and global populations—the so-called ‘Silver Tsunami’—means that an increasing number of us will require long-term care when we can no longer care for ourselves,” said Spetz. “Simply managing the activities of daily living often requires ongoing care from a combination of licensed and unlicensed health workers. We believe that the demand for these workers will increase significantly in the coming years.”


The Center will receive approximately $300,000 of funding for its first year, in which it plans to study three major focus areas, says the HWRC’s deputy director Susan Chapman, PhD, RN, associate professor in the Department of Social and Behavioral Sciences at the UCSF School of Nursing. Researchers will also conduct special short-term projects related to current hot issues from either a national or regional perspective. 

The goal is to analyze state data so health policy decision-makers will have the information needed to devise tools and strategies ensuring an adequate workforce to meet the U.S.’s long-term care needs, Chapman says. 

The first focus area will explore differences in training requirements for personal care aides. Researchers are not specifically looking at care settings, but rather state-by-state training requirements for personal care aides, and it’s expected at least some of them will be employed in assisted living or other senior living settings, including private residences.


“There are nearly one million people working in this field in the U.S., but there is little consistency in the training requirements across states,” the research center notes.

Training requirements and whether or not they should be standardized across the nation is a conversation that’s happening at multiple levels, Chapman says. There are current minimum standards for certified nurse assistants (CNAs) and home health aided working for certified home health agencies, but there are no standard requirements for personal care aides.

“One of our goals is to get information out about current state training requirements , and do so in a way that policymakers can use the information,” Chapman says, adding that the Center may also create an interactive map on its website that displays the requirements state by state in a format that could be useful to providers, other states, and policymakers.

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How training requirements relate to quality outcomes, however, is still largely unknown when it comes to personal care aides. 

“There’s a dearth of research in tying training to outcomes,” says Chapman. “The next big piece of research is to look at what difference training makes at patient-level outcomes, staff turnover, provider and consumer safety, and other outcomes.”

The second study’s goal is to extend existing prediction models forecasting demand for long-term care to understand how future changes in the settings in which that kind of care is delivered translates to changes in the need for long-term care workers.

The final study will analyze long-term care worker turnover and examine wage differences that appear between entry and exit in the senior living field. 

Training requirements can be significant from a worker perspective, Chapman says, with issues to explore including whether training improves workers’ employability, leads to higher wages, or helps better retention rates. 

The Health Workforce Research Center, led by Spetz and Chapman, represents a collaboration among the Institute for Health Policy Studies, the UCSF Center for Health Professions, and the UCSF School of Nursing.

Written by Alyssa Gerace