6. Conclusion

Probably one of the main contributions of this project is that roughly a year ago, conversations about workforce and economic development efforts in the state rarely considered the importance of access to affordable and reliable dependent care services. Therefore, the groups involved in this first-phase effort were among the first to consider and propose solutions to this issue.

Concerted efforts to improve the size and quality of the workforce have conventionally focused on strategies to increase access to training and educational opportunities. Although the importance of such initiatives cannot be minimized, the most trained and educated worker with dependents cannot possibly participate in the workforce without access to affordable and reliable dependent care services. Research shows that investments in child care – especially in high-quality early care for children ages 0 to 5 from low-income families – have demonstrated to be more advantageous and yield a higher return on investment than more traditional economic and workforce development tools. Although largely overlooked, dependent care services function as a two-fold economic development tool by freeing people to (1) take part in educational and training programs and (2) enter or re-enter the workforce. High-quality child care programs also set a strong foundation for the workforce of the future. 

Data also indicate that caregiving is an important determinant of nonparticipation in the labor force, especially in the case of women. Notably, in terms of quantity, caregivers represent the largest group of people who can potentially move into the labor force. Nevertheless, dependent care services are often in short supply, expensive and out of reach for working families in West Virginia. The traditional, for-profit business model does not offer enough financial incentives for new providers to enter the market, and those that are currently in the industry struggle to stay in business. High operational costs, regulatory barriers and thin or inexistent profit margins are among the reasons many providers close doors. These issues have become even more pronounced as a result of the COVID-19 crisis. Also, even though the demand for dependent care professionals has steadily increased – such occupations are expected to be among the top-10 fastest growing in the U.S. [230] – providers have difficulties in finding enough workers due to poverty wages and the high demands of the job.

As outlined in Section 4, the cost calculator tool, the shared services business model, the sharing economy business model, the Rural Studio Model, intergenerational care, leadership training on business management, family child care pods, and a social or hybrid model for adult day programs could all function as more efficient and sustainable ways to provide care in West Virginia. 

With that, this white paper seeks to identify the main challenges dependent care providers face in the delivery of services and highlight policy considerations, potential solutions, innovative business models and ideas that can help them realize cost savings, achieve improved efficiencies and meet the needs of working families in West Virginia. The challenges and suggestions outlined in this paper are by no means all-encompassing and reflective of the reality and conditions of all providers in the state. There were a number of challenges across the board during the research phase of this project, including difficulties in getting in touch with providers, due to limited bandwidth and resources, capacity issues and later COVID-19 closures, which hindered our ability to reach them as well as fully understand the problem and appropriately frame survey questions.

Additional suggestions and policy considerations that can help address the barriers to workforce participation identified in this paper include [231]:

• Without dedicated funding and support, dependent care services will likely become even more scarce and expensive in the state. Since in rural settings dependent care businesses may not be considered inherently profitable ventures, providers need to have access to supplemental funding – and expertise, time and other resources – from groups in the public sector (local, state and federal governmental entities) and private sector (businesses, foundations, community organizations). These groups would profit from such initiatives because of the ensuing economic benefits of freeing more people to participate in the workforce and having more children enrolled in high-quality child care programs [232]. For these reasons, West Virginia can benefit from a more robust, systematic way of providing financial support to dependent care providers, with a mix of public and private funding, potentially in the form of public-private partnerships. A guide to successful public-private partnerships for child care can be found in a footnote [233].
• West Virginia foundations that wish to provide funding and support to both public and private child care providers can carry out funding initiatives, in the form of mini-grants, in partnership with their regional Child Care Resource and Referral (CCR&R) agencies [234]. For instance, a group of Wood County foundations have put together a joint funding initiative, in collaboration with Choices CCR&R and in response to the financial strain brought about by the COVID-19 pandemic, to provide mini-grants to public and private providers in the region. This initiative is a great example of a potential way foundations can indirectly support private child care providers in West Virginia.
• Families and communities can benefit from informational sessions and educational materials on the importance and benefits of adult dependent care services to both caregivers and their dependents. For example, many families are not aware that there are support groups and respite care available to them. Informational sessions can be facilitated by senior county providers [235] or associations (e.g., AARP West Virginia, the Alzheimer’s Association), in partnership with faith-based groups, to provide education about services in different areas of the state.
• Providers could use broad community resources – like resource networks, agencies or organizations – to better align services, which may help promote economies of scale and avoid duplication of services. One survey respondent suggested holding monthly meetings with other local providers to facilitate this goal.
• Centralized marketing through shared service alliances can also benefit adult dependent care providers and help them better target customers and attract additional clients. A robust online presence, even if accomplished through a centralized webpage that connects clients and providers throughout the state or a particular region, can help providers better market themselves and make it easier for current and potential clients to reach them. A centralized webpage can also function as a one-stop-shop to help caregivers navigate different options available to them and their dependents and even include information about different subsidies available to them. In essence, appropriate marketing, branding and messaging can be quite useful in the successful sustainability of adult day programs.
• Since the Medicaid Aged and Disabled Waiver (ADW) program is only for individuals who qualify for nursing home care, West Virginia can benefit from developing an additional waiver program that would cover adult day services.
• Employers, in turn, regardless of size and whenever feasible, can better support their workforce by offering flexible work schedules, including telework and unconventional work shifts, to promote family-friendly work policies [236]. Larger employers may consider adding a dependent care component to their benefit packages or partnering with local dependent care providers to offer care [237].
• Child care providers report that some of the financial concerns they have could be eased if state reimbursement rates were based on enrollment and not attendance.
• The development of real time supply and demand data matching systems [238] to connect working families with available child care slots in the state (to better match supply and demand) has the potential to not only help caregivers access such services, but also solve under-enrollment issues that render child care businesses unsustainable [239].
• Adult dependent care providers can also benefit from having access to an expert on all the different regulatory pieces – someone with a sound understanding of the eligibility criteria for state and federal programs and benefits as well as compliance with reporting requirements. The regulatory advisor could troubleshoot for dependent care businesses around the state – or a particular region – helping to free dependent care workers to focus on their main task of providing care to clients.
• Adult day providers in West Virginia can also benefit from visiting some of the premier and successful private not-for-profit adult day programs in other states. Presently, most adult day programs in the state are operated within the County Aging programs, but some states take a different approach [240].  
• A group of partners or task force may be formed with the purpose of implementing some of the suggestions outlined in this white paper and test novel ideas in their programs and communities. Members of the task force can include representatives from foundations, higher education institutions, dependent care providers, local employers, regulatory and government agencies, think tanks and economic and community development organizations. The main goal would be to identify which models would best fit the unique needs of different regions of the state and how the task force could collectively put select business model ideas into practice.