The Mission, Work, and Advocacy of the Eldercare Workforce Alliance

By Jessica Nagro and Michèle J. Saunders

The Eldercare Workforce Alliance (EWA) is a group of thirty-one national organizations, joined together to address the immediate and future workforce crisis in caring for an aging America (see below for a roster of EWA members).

The Institute of Medicine (IOM), in its critical 2008 report Retooling for an Aging America: Building the Health Care Workforce, called for immediate investments in preparing our healthcare system to care for older Americans and their families. In response, the national Eldercare Workforce Alliance was formed—representing consumers, family caregivers, the direct care workforce, and healthcare professionals—to propose practical solutions to strengthen our eldercare workforce and improve the quality of care.

Nancy Lundebjerg (American Geriatrics Society) and Michèle Saunders (Gerontological Society of America) are the Alliance’s elected co-conveners. EWA amplifies its work through partnerships with several federal liaisons including the U.S. Department of Veterans Affairs, the Administration for Community Living, the Health Resources and Services Administration, and the Office of Women’s Health at the U.S. Department of Health and Human Services.

The EWA Membership

EWA membership includes the following organizations: AARP, Alzheimer’s Association, Alzheimer’s Foundation of America, AMDA—The Society for Post-Acute and Long-Term Care Medicine, American Academy of Nursing, American Association for Geriatric Psychiatry, American Geriatrics Society, American Nurses Association, American Physical Therapy Association, American Psychological Association, American Society of Consultant Pharmacists, the American Society on Aging, Caring Across Generations, Coalition of Geriatric Nursing Organizations, Community Catalyst, Cooperative Development Foundation, Council on Social Work Education, Family Caregiver Alliance, Gerontological Society of America, LeadingAge, National Alliance for Caregiving, National Association for Geriatric Education, National Association of Social Workers, National Consumer Voice for Quality Long-Term Care, National Cooperative Bank, National Council on Aging, National Hispanic Council on Aging, NCB Capital Impact/THE GREEN HOUSE® Project, PHI—Quality Care through Quality Jobs, SEIU Healthcare, and the Social Work Leadership Institute.

EWA’s Work

Since its inception in 2008, EWA has consistently responded to the changing healthcare environment. Its membership represents an inclusive group of eldercare workforce stakeholders and provides a true balance of paraprofessional and professional voices. Thanks to initial support from The Atlantic Philanthropies and The John A. Hartford Foundation (JAHF), and more recently by JAHF and member contributions, the Alliance has the necessary funding to ensure consistent staff dedicated to the mission of building a caring and competent eldercare workforce.

The Alliance is also widely respected as a one-stop shop for Washington, D.C., policy makers when they explore eldercare workforce issues. EWA’s Public Policy Committee holds regular calls to foster constant member dialogue and thoughtful discussion around policy proposals. The calls allow for the careful vetting
of Alliance positions and the inclusion of a wide variety of stakeholder opinions in EWA decision-making. Specific EWA positions, programs, or proposals require support from a 75 percent supermajority of its membership, leading to comprehensive and consistently reliable policy products.

Anne Montgomery, former Senate Special Committee on Aging staffer and current senior policy analyst at the Center for Elder Care and Advanced Illness at the Altarum Institute, observes that “The Eldercare Workforce Alliance is a go-to source for thoughtful, evidence-based policy analysis on how we can best build a broad, interdisciplinary workforce as the U.S. ‘age wave’ accelerates.

“The Alliance’s membership of thought leaders is broad and diverse, bringing breadth and depth to its recommendations. Stakeholders and policy makers have long relied on EWA’s expertise and leadership in formulating decisions about how to improve the workforce’s capacity to efficiently serve millions more older Americans during the twenty-first century.”

EWA’s work engages policy makers, providers, consumers, and family caregivers in addressing the eldercare workforce shortage problem through a wide range of channels. The Alliance has developed strong relationships with Capitol Hill and the Administration through meetings, briefings, and policy letters. Staff regularly serve as experts at conferences and on panels, bringing the often overlooked workforce component to aging and health policy discussions. Videos, social media, and press outreach also allow the Alliance to interact with new audiences and increase its advocacy impact.

Advocacy in Action

During its seven-year tenure, EWA has been successful in advancing several of the recommendations of the IOM report across various settings and priorities, as follows:

  • The Alliance successfully advocated for the inclusion of provisions on geriatric education and training, as well as training of the direct care workforce, in the Affordable Care Act. This included an expansion of the Geriatric Academic Career Awards to additional disciplines, the inclusion of the direct care workforce in Title VII definitions of healthcare providers, as well as authorization of several geriatric training opportunities and a Medicaid demonstration for direct care workers. Since its inception, EWA also has successfully advocated to preserve Title VII and VIII funding, even when sequestration resulted in many other programs being significantly cut or eliminated.
  • Through letters and comments to Labor Secretary Hilda Solis, press releases, and op-eds, EWA urged the U.S. Department of Labor to extend the Fair Labor Standards Act minimum wage and overtime protections to home- and community-based services workers. The final rule ensuring these rights was released in 2013 and took effect in October 2015.
  • Additionally, EWA educated the Center for Medicare & Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services on the importance of workforce issues when testing new models of delivery system reform. Due to this advocacy effort, the first round of CMMI Innovation Grants included a workforce component as one of the key objectives, namely to “identify new models of workforce development and related training and education that support new models either directly or through new infrastructure activities.”

Collaborations Bear Fruit

Through collaboration and the development of tools and resources, EWA has advanced the work of the eldercare workforce and strengthened the EWA mission and those of its coalition partners.

The Alliance collaborated on an issue brief promoting the concept of an Advanced Direct Care Worker. Over a nearly three-year period, EWA convened a series of roundtable discussions with physicians, nurses, direct care workers, and social workers, and conducted a survey of family caregivers to develop this concept. The brief argues that direct care workers, with appropriate training and supervision, can assume more responsibility for the care of older adults in their homes and promote person-centered care. This concept encourages a career ladder for direct care workers, which can lead to more health professionals working at the top of their license or certification, and supports retention of welltrained workers.

EWA also paired with Community Catalyst, a coalition member and national consumer advocacy organization, to create a toolkit to advocate for a stronger, interdisciplinary workforce for use
in states pursuing redesign of healthcare delivery for Medicare and Medicaid dually eligible beneficiaries. The toolkit was launched in October 2014 for the six states in which Community Catalyst is working, but also is available on the EWA website for use by interested advocates in all states.

Over the years, EWA also has supported family and other unpaid caregivers by developing a Web-based resource that provides information on eldercare issues and expansion of the role of caregivers in the National Plan to Address Alzheimer’s Disease. 

Speaking about the Alliance’s work on behalf of family caregivers, Kathleen Kelly, executive director of the Family Caregiver Alliance, said, “Without EWA’s knowledge, connections, and dedication to [critical eldercare workforce issues], the needs of caregivers and the rest of the eldercare workforce would be sorely underrepresented in our nation’s capital. The value of the Alliance’s work is shown every day in the faces of family caregivers across the country who receive resources from the policies and programs supported by EWA.”

The Alliance is engaged in several advocacy and legislative efforts that build upon past successes and continue the mission of ensuring that our healthcare workforce is prepared to provide high-quality care to older adults.

EWA’s Ongoing Mission

EWA has continually supported geriatric workforce education and training through Title VII and Title VIII programs administered by the Health Resources and Services Administration (HRSA). This year, the programs again are at risk of being scaled back, and EWA is working actively to ensure Congress understands the importance of these critical programs and provides adequate funding to ensure their success.

EWA also is a strong advocate for reauthorization of the Older Americans Act. This legislation provides vital supports to older adults and family caregivers and helps ensure access to the long-term services and supports needed to help older adults remain in their communities. Additionally, EWA supports legislation that will allow advanced practice registered nurses and physician assistants to order home health services under Medicare, which will help to deliver vital care to older adults without unnecessary delays.

As the aging of the population continues, the numbers of people needing a well-trained workforce sensitive to their needs will continue to expand. The Alliance has created an important niche for itself where none existed before. EWA’s diverse and engaged membership, the recognition it has received on Capitol Hill and in the Administration, and its carefully crafted messaging to policy makers, other stakeholders, and to the public have positioned EWA to make lasting change in advancing the eldercare workforce.

Jessica Nagro, M.P.A, is the policy and communications manager for the Eldercare Workforce Alliance, Washington, D.C. Michèle J. Saunders, D.M.D., M.S., M.P.H., is the co-convener of the Eldercare Workforce Alliance.

Editor’s Note: This article is taken from the Spring 2016 issue of ASA’s quarterly journal, Generations, an issue devoted to the topic “America's Eldercare Workforce: Who Will be There to Care?.” ASA members receive Generations as a membership benefit; non-members may purchase subscriptions or single copies of issues at our online storeFull digital access to current and back issues of Generations is also available to ASA members and Generations subscribers at Ingenta Connect. For details, click here.