What Does DEI Stand For?

Diversity is about representation – who is in the room and who’s not in the room.  As the world becomes increasingly more diverse, how do we make sure we reflect the community that we serve and that we’re also leveraging the opportunities that come with diversity?

Equity recognizes that not everyone starts from the same place and acknowledges and makes adjustments to imbalanced social systems to help every person thrive.

Inclusion is about making sure that the people in your community know that they are welcome and they belong. Retention is about creating an inclusive culture so that people are engaged and feel like they belong.

(Source: 2020 Fall/Winter Oregon Caregiver magazine)

Why is DEI Important in Long Term Care?

The long term care sector serves a diverse resident population and is made up of an increasingly diverse workforce. It’s imperative that our sector works to enhance DEI to ensure that staff, residents, and families feel welcome and valued in long term care settings and that the care residents receive is equitable and takes into consideration residents’ unique backgrounds, lived experiences, and desires. Additionally, creating a more inclusive and equitable workforce in long term care will more equally distribute opportunity and empower the staff to provide the highest quality person-centered care possible to residents and families.

The significant racial and ethnic disparities within the U.S. long term care sector regarding access to care, quality of care, and service delivery are well documented (Gorges et al., 2019; Rivera-Hernandez et al., 2019; Shippee et al 2020). The COVID-19 pandemic was an unprecedented crisis that disproportionately impacted the long term care sector. Racial and ethnic minority populations, specifically Black, Indigenous, and other people of color, have been particularly impacted by the devasting effects of the pandemic, including the residents of long term care settings as well as the long term care workforce. A comprehensive understanding of the populations and communities who utilize and provide care in Oregon is essential to mitigating pandemic-induced impacts, reducing disparities in service provision, and ensuring greater equity in outcomes.

Several sources offer useful data on the utilization of Oregon long term care services and who provides these services. These include Oregon-specific resources such as the annual Portland State University Community-Based Care Report and the annual Oregon State University’s Oregon Nursing Facility Report. National sources such as PHI’s Workforce Data Center, the US Census Bureau, and the U.S. Bureau of Labor Statistics also provide Oregon-specific data on the long term care workforce. Yet, gaps remain within the available data. Filling these data gaps is essential to obtain a more complete picture of current needs in Oregon and for the decades ahead.

The Data

Long Term Care Workforce Generally

Gender: The vast majority of Oregon’s direct care workforce is female (81% female versus 19% male) (PHI, 2021). There is little variation in the gender distribution across nursing facilities, community-based care, and home care sector. The high proportion of women working in Oregon long term care communities is similar to that of the sector’s workforce in the United States. Further, 26% of all direct care workers in Oregon have young children (PHI, 2021). This includes 35% of staff in skilled nursing facilities, 34% of staff in assisted living/residential care communities, and 20% of all Oregon home care workers. The demanding nature of the caregiving profession intersects with the need for childcare (and often caregiving for aging parents).

Age: More than 29% of Oregon’s home care workforce is 55 years of age or older with 11% currently over the age of 65 (PHI, 2021). This differs from licensed care settings where the workforce is generally younger. An aging workforce may present specific challenges given the demanding physical nature of caregiving services. Further, many members of Oregon’s nursing profession are at or near traditional retirement age, which may contribute to a shortage of nurses. At the same time, it is projected the need for nurses will grow by as much as 15% by 2028 (US Bureau of Labor Statistics, 2022). Understanding how age intersects with other demographic factors is essential to training and recruiting a workforce that will provide for the long term care needs of Oregon’s increasingly diverse population.

Race/Ethnicity: Oregon’s long term care workforce is highly diverse. Racial and ethnic minority populations make up a slightly larger share of the long term care workforce than of Oregon’s population overall. Approximately 31% of Oregon’s long term care workforce are people of color, compared with approximately 25% of Oregon’s overall population (PHI 2021; US Census Bureau, 2020). There is also some variation in workforce demographics across Oregon’s long term care settings. A gap in the long term care workforce data is the percentage of the workforce who are Indigenous Oregonians. (See Table 1 for further detail).

Long Term Care Consumers

Gender: Similar to national trends, the vast majority of all long term care service recipients in Oregon are women. Some variation exists across care settings. For example, 70% of assisted living and residential care community residents are women, while 71% of residents in Oregon’s memory care communities and 57% of residents in skilled nursing facilities are women (Carder et al 2020; Mendez-Luck et al 2020).

Race/Ethnicity: Oregon’s population is growing increasingly older as well as increasingly diverse. About 10% of Oregon assisted living and residential care residents are non-white, while residents of Oregon’s skilled nursing facilities are nearly 18% non-white (Carder et al 2020; Mendez-Luck et al 2020). There is little data available on the demographics of Oregon in-home care recipients, which is a significant gap given that the majority of all long term care recipients receive in-home care rather than care provided in licensed settings. Table 2 provides additional detail by long term care setting.

Table 2: Demographics of Oregon Long Term Care Sector Residents

ALF/RCF Memory Care Nursing Facilities
Hispanic/Latino of any race 1.0% 1.0% 1.5%
American Indian/Native American or Alaska Native 1.0% 0.0% 0.5%
Asian 1.0% 1.0% 1.2%
Black/African American 1.0% 1.0% 1.8%
Native Hawaiian/Other Pacific Islander 0.0% 0.0% 0.2%
White 91.0% 90.0% 82.2%
Two or more races 0.0% 0.0% 0.1%
Other or unknown 5.0% 7.0% 12.6%
Total 100% 100% 100%

Source: Carder et al (2020). Portland State University and Mendez-Luck et al. (2020).

Rural/Frontier: Oregon’s rural and frontier communities face unique challenges in terms of accessing long term care services and in service delivery. Indeed, Oregon’s rural and frontier communities have long confronted a workforce shortage, especially of licensed staff such as certified medication aides (CMAs). Individuals and families must often travel great distances to obtain health and long term care services. Understanding the demographics and needs of Oregon’s rural and frontier communities is essential to ensuring appropriate care provision across geographies.

LGBTQ+: Some of of Oregon’s older LGBTQ+ population report living in congregate settings such as senior housing (6%), assisted living facilities (3%), adult foster homes (3%), and nursing facilities (3%).

Data Sources

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