In late 2023, Lee Health, one of the largest public health systems in Florida, began a virtual nursing pilot designed to understand the opportunities and implications of shifting this vital role into a virtual environment. I sat down with three Lee Health leaders responsible for the design and implementation of the virtual nursing pilot — Kim Gault, MSN, RN, business system analyst for virtual health and telemedicine; Max Rousseau, supervisor of virtual health and telemedicine; and Jonathan Witenko, system director, virtual health and telemedicine — to learn more about why this was a priority for the organization, the considerations they made, and the outcomes they’re seeking. This conversation took place over two interviews and has been edited for clarity.

LeeHealth is the largest public health system in the state of Florida, serving Lee County and the surrounding areas. With over 14,000 employees and 1,800 beds, the nonprofit system engages with more than 2 million patients each year through its four acute care hospitals, two specialty hospitals, multiple skilled nursing facilities, outpatient centers, and walk-in clinics. Like many health care systems, Lee Health has persistent and acute challenges within its talent pipeline, especially among frontline staff. In nearly all hospitals, some patients require more monitoring and support than clinical staff can provide. These patients may be at risk of falling, struggle with confusion or agitation, or be at risk of harming themselves or others. The system had been exploring moving to virtual monitoring and observation for years, shifting the “safety tech” role from in-person to virtual. Lee Health needed a unified system that could enable quick decisions, comprehensive information, and, especially, clear communications between safety techs and clinical staff. After safely piloting the virtual safety tech role, employees are now observing patients in all four acute care facilities. The program has resulted in improved job quality for techs and cost savings for the system. Supported by effective upskilling and thoughtful implementation, Lee Health realized financial benefits and created new capacity to support patients and clinical staff.

Improving job quality not only transforms workers’ lives, but it also benefits businesses’ performance and bottom lines. Highlighted in this brief is Sunrise Treatment Center, a leader in the addiction treatment sector that provides stable, sustainable jobs. Founder Dr. Jeffrey Bill, Chief Operating Officer Steven Smith, and Chief Human Resources Officer Brett Burns developed strategies to simultaneously meet the needs of their patients and their commitment to employees. Sunrise Treatment Center saw sustained growth and improvement in both capacity and caregiving by ensuring that the focus of the organization was explicitly two-fold: to provide the highest quality treatment for patients with substance abuse issues and mental illness, and to offer a great place to work for employees.

The COVID-19 pandemic has underscored the value of caregiving work and the need for equitable and affordable access to care – for children, for elders, for those with a disability, and for all of us in hard times. Yet care work remains underpaid and often invisible, contributing to the inadequacies of the US care system and deepening challenges for caregivers and families. As we move from crisis to recovery, how can policy contribute to building a care economy that dignifies the work of caregivers and expands access to quality, affordable care? How can our systems center gender and racial equity to construct a care economy that serves all families? And how can our society support a healthy and sustainable caregiving system for our post-pandemic future, one in which the demand for caregiving is poised to continue to grow?

The American population is getting older. The US Census estimates that, in 2050, the population aged 65 and over will be 83.7 million, almost double its estimated population in 2012, and the surviving baby boomers will be over the age of 85. As the United States ages, direct care workers, such as home care aides and certified nursing assistants, will become essential to many more families. Yet these workers tend to be low-paid and poorly trained and receive little respect for the critical work that they do.

During this event, the panel discusses if such a workforce is capable of addressing the needs of our aging population, and how can we improve the quality of work and healthcare services in an industry of growing national importance.

This issue brief by PHI analyzes the impacts of recent policy changes in New York state impacting home care aides and defines what a quality job looks like for a caregiver. The elements of a quality job in this occupation are organized in three categories: compensation, opportunity, and supports. While designed for care workers, the framework has relevance across industries and application for all practitioners seeking to define and assess job quality in an organization.

By 2050, the number of Americans needing long-term care services and supports will double. They will have more acute and complex care needs than previous generations, and they will be more likely to receive care at home or in a residential setting than in an institution. These factors are driving the increased demand for workers providing home care services and for better training. One of the biggest workforce challenges we face as a country is how to meet the growing demands for such a critical workforce. One model has emerged in Washington State: The SEIU Healthcare NW Training Partnership. Founded in 2007, this nonprofit school is the nation’s largest training provider for workers in home care. The Training Partnership has created a statewide training system with comprehensive resources and tools to support home care workers, consumers and employers. This case study provides an overview of the Training Partnership and its history, offerings—-including the nation’s first Registered Apprenticeship program for home care workers—-and outcomes. It also summarizes the model’s strengths and challenges. The development of this case study was generously supported by SkillUp Washington and the Ford Foundation.