Family and Friends are the Invisible Workforce in Long-term Care

In a recent study published in Health Affairs, Normae Coe, PhD and Rachel Werner, MD, PhD find that family members and friends are an invisible workforce in nursing homes and residential care facilities. They've expanded on these findings in a piece for Penn LDI. The extent to which families and friends provide support and care is surprising since there is an assumption that facilities have paid staff to do this work. Coe and Werner note that long-term care policies must be reassessed to better serve and support all involved.

From Penn LDI

We can’t tell if this informal care is provided based on preferences of the elder and family members or due to needs of the residents being too great for the staff to meet alone. If it is the latter, it raises concerns about adequacy of staffing levels in nursing homes. It also raises questions about how needs are met among people who don’t have informal caregivers. Are their needs going unmet, or do staff spend more time with these residents, creating an implicit cross-subsidization between residents with and without family helpers?

Our findings help to explain the stories of staffing shortages and burnout in nursing homes under COVID despite no apparent drop in staff hours, when visitor bans were one of the first policy responses to the outbreak. The bans essentially eliminated this invisible workforce, increasing the care demands on the staff, on top of the extra work of the COVID protocols and infections themselves.