Last month, we examined Northwest Minnesota's healthcare workforce challenges. This month, we're looking ahead to understand what's driving demand and where opportunities for solutions might emerge. The focus on long-term care stems from key findings on Nursing Assistants surrounding their essential role in elderly care, their critical importance to the entire healthcare system and their status as the career path with the third highest number of job vacancies in the Northwest with a nearly 20% vacancy rate.

Workforce Dynamics in Key Industries

DEED's industry projections show Nursing Homes – the largest employer of Nursing Assistants (43% statewide) – are projected for modest future employment declines, while Home Health Services and Assisted Living Facilities are expected to show solid growth (Table 1).

General Medical & Surgical Hospitals are a distant second-largest employer, employing 27% of Nursing Assistants, followed by Assisted Living Facilities at 11%. However, Assisted Living relies more on Personal Care Aides. Nursing Homes are required to provide care by Nursing Assistants, whereas Assisted Living Facilities are not. Likewise, Home Health Care Services rely most heavily on Personal Care and Home Health Aides, employing only 2.5% of Nursing Assistants.

The Opportunity: It's About Retention, Not Just Recruitment

The Nursing Assistant occupational projections provide a key insight: most job openings are from turnover rather than new demand. For every one opening from growth, there are 89 openings from turnover. More specifically, the job openings are overwhelmingly from Nursing Assistants transitioning to different occupations or leaving the labor force altogether. This is demonstrated by the last three columns of Table 2, which show labor market exit openings and occupational transfer openings, as well as a projection of total openings, which also includes new jobs created (Table 2).

Even though there are fewer than 50 projected new openings from growth in the number of Nursing Assistants in the Northwest region, there are over 4,400 total openings from 2022 to 2032. An estimated 55% are from Nursing Assistants leaving these jobs for another occupation, and 44% are from those leaving the labor force. The implication is that the greatest opportunity to meet Nursing Assistant staffing needs is to increase retention.

Putting Turnover in Perspective

Nursing Assistants are among some of the highest turnover occupations in the region, resting at a well-above-average 71% turnover rate, compared to 56% for all occupations. Other high-vacancy positions with similar wages or educations include First-Line Supervisors of Retail Sales workers (49%), Teaching Assistants (Paraprofessionals) (49%) and First-Line Supervisors of Food Prep and Serving Workers (73%). By this measure, Nursing Assistants have the second-highest projected turnover rate.

The Evolving Care Landscape

Given the Nursing Assistant turnover, the -1.6% projected Nursing Home employment drop in Northwest Minnesota is insignificant for the future demand. But why do we project essentially flat employment in Nursing Homes? Northwest Minnesota's population is not getting any younger. According to population projections from the State Demographic Center, from 2025 to 2035 in Northwest Minnesota, the population of those age 75 to 84 will grow 34% and those age 85 and older will grow 19%.

The Profile of Older Americans (U.S. Health and Human Services Administration for Community Living, 2023) estimates that 3% of those age 75 to 84 and 8% of those age 85 and over reside in Nursing Homes. Applying this to the population projections, I estimate an increase of 675 Nursing Home residents by 2035, or 26% growth.

That is inconsistent with the employment projections, so either the employment projections are wrong, or more likely there will be a smaller percentage of elderly cared for in Nursing Homes in the future, instead choosing other options.

The Care Continuum Expansion

The trend has been a decreasing percentage living in Nursing Homes because Assisted Living Facilities and Home Health Care Services have grown to meet the care needs of many elderly who need assistance, but not the level of care Nursing Homes can provide. Nursing Homes have evolved to only serve those needing constant or specialized care.

Industry employment trends reflect this evolution, where Assisted Living Facilities and Home Care providers now care for those who need assistance with activities of daily living. This is why there is a slight decline projected in Nursing Home employment, as employment shifts to Assisted Living Facilities and Home Health Care Services. It is also why there is roughly 12% growth projected for Home Health Care Services and Assisted Living Facilities, as well as Home Health & Personal Care Aides rather than Nursing Assistants.

This shift represents progress in meeting diverse senior care preferences while optimizing resource allocation. However, this adaptation has natural boundaries. The Northwest's age 85 and over population is expected to grow by over 8,800 people (54%) from 2025 to 2045! Barring miraculous medical breakthrough, more individuals will require the specialized, intensive care than Nursing Homes provide – particularly those with complex medical conditions or severe mobility limitations that exceed what Assisted Living or Home Care can accommodate.

Looking Ahead: Questions and Opportunities

This analysis raises important strategic questions for our region: How can we ensure adequate care capacity as our most care-intensive senior population grows significantly? Can this care be provided without more Nursing Assistants to staff Nursing Homes? If so, how? Several potential solutions merit exploration:

Workforce Innovation:

• Enhanced training and career pathways that improve retention
• Technology integration that supports care efficiency
• Creative staffing models and scheduling approaches

Care Delivery Evolution:

• Continued expansion of intermediate care options
• Integration of telehealth and remote monitoring
• Partnerships between care settings for seamless transitions

Community Solutions:

• Family caregiver support programs
• Volunteer networks and community-based assistance
• Housing innovations that blend independence with support services

Moving Forward Together

Northwest Minnesota's long-term care challenge reflects immutable demographic trends, but our region's collaborative spirit positions us well to develop innovative solutions. The data shows retention improvements offer the most immediate impact, while longer-term success will require innovations in medical care, creative approaches to care delivery and unique workforce development.

I see a potential crisis on the horizon, but this represents an opportunity to build a more resilient, responsive care system that serves our growing senior population effectively while creating meaningful career opportunities for healthcare workers.

For more information about Health Care employment in Northwest Minnesota, contact Anthony Schaffhauser at Anthony.Schaffhauser@state.mn.us.