Massachusetts Office of Public Collaboration

A Neutral Forum for Conflict Resolution and Consensus Building

MA Eldercare Workforce Project

Project Summary

Massachusetts is facing an impending health care crisis in connection with its ever-increasing population of aging adults. Starting in January 2011, 10,000 Americans will turn 65 every day for nineteen years. The challenge posed by the scale of this expanding demographic is further complicated by changes in the demands of the elderly resulting from longer life spans, dispersed families, solo living, and the desire for independence and aging in place. Massachusetts, like the rest of the country, finds itself inadequately prepared to meet this challenge due to anticipated shortages in the workface caring for the elderly.

Based on findings in a 2008 Institute of Medicine Report, a robust response to the challenge of elder healthcare workforce shortages would involve the transformation of the current state of health care delivery, including the integration of medical and social support systems, private and public strategies and investments, and a supportive public constituency.  In line with its mission to function as a state level resource for public collaboration on important policy issues, the Massachusetts Office of Public Collaboration (MOPC) has embarked on a multi-phase project to develop a state-wide integrated alliance that addresses these workforce deficiencies in Massachusetts, modeled on the national Eldercare Workforce Alliance launched in response to the IOM report. 

In the first phase of this Eldercare Workforce Project, MOPC was awarded grants from the Blue Cross/Blue Shield Foundation of Massachusetts and the John A. Hartford Foundation to assess the willingness of MA stakeholders to participate in such an enterprise and to come to the table to explore common interests and form a consensus agenda for joint action. The MOPC project lead, an affiliate who had been a facilitator for the national initiative, designed the MA assessment, conducted the stakeholder interviews and prepared the assessment report.  Fifty-four individuals – representing professional and para-professional health care providers and employers, academics, researchers, family caregivers and consumers – were interviewed about the challenges and controversies facing collaborative health care efforts, areas of shared interests and consensus among stakeholders, the conditions necessary for stakeholder participation, and the important goals and actions to be undertaken by a stakeholder collaboration.

The assessment identified time and energy required by coordination, competition over scarce resources, tension between disability and eldercare advocates, and the difficulties with fashioning eldercare into a rewarding career as generally recognized barriers to any potential consensus about meeting the workforce challenge. There was widespread agreement about the anticipated workforce crisis – as exacerbated by ageist attitudes manifested by the avoidance of end-of-life issues and eldercare’s low prestige – and the need for such changes as heightened public awareness, payment reform, increased education and training in geriatric care, expanding the category of health care providers to include informal caregivers, and the development of new models of care, particularly inter-disciplinary teams. The conditions for developing a collaborative approach were found to involve the participation of a broad array of stakeholders in a process characterized by strong leadership, clarity about expectations and goals, collaborative problem-solving, clear communication, realistic time lines, and sufficient resources. Potential goals suggested by group of interviewees included education and outreach about the looming aging health care crisis, about alternative models, and so on.

Interviewee optimism about stakeholder participation in an inter-institutional negotiation to form a MA alliance is a promising sign that momentum for a collaborative negotiation over eldercare work issues is developing during this early stage of the project. For phase two, MOPC is seeking resources to convene stakeholders in an alliance-formation and consensus-building to take collaborative action in addressing this workforce crisis.  MOPC is also currently engaged in exploring opportunities to replicate this project in other states through the University Network for Collaborative Governance.


Moore, P.W. (November 14, 2011). Report to the Blue Cross Blue Shield of Massachusetts Foundation: Massachusetts Eldercare Workforce Alliance Planning initiative assessment phase report. Massachusetts Office of Public Collaboration, University of Massachusetts Boston.