From Nursing Homes to Home Care: Examining the Impact of the COVID-19 Pandemic on Direct Care Worker Transitions.

Objectives: Due to poor working conditions and low wages, workforce turnover in the long-term care industry has been a longstanding issue. Increased risks to workers caused by the COVID-19 pandemic exacerbated these issues. Thus, many states offered wage supports (eg, hazard pay) to try to stabilize the workforce. Our objective was to examine how exits of direct care workers employed in the long-term care industry changed during the COVID-19 pandemic, and whether hazard pay policies mediated the impact of the pandemic on worker exits.

Design: We used the Annual Social and Economic Supplement to identify direct care workers and PHI reports to identify states offering hazard pay during the pandemic.

Setting And Participants: The analytical sample consisted of 8164 direct care workers employed in long-term care between 2016-2018 and 2020-2022 in 2 settings: (1) home settings and (2) residential care settings (nursing homes and assisted living).

Methods: We decomposed direct care worker exits using the Annual Social and Economic Supplement survey responses to (1) unemployment or exiting the labor force, (2) a different health care job or industry, and (3) non-healthcare job (eg, retail). We compared the rates of these components for direct care workers prepandemic (2016-2019) and during the pandemic (2020-2023), and the association of these rates with state wage-support policies.

Results: Direct care worker exits were highest in 2020, with most workers becoming unemployed or leaving the labor force. In 2021-2022, worker exits decreased relative to prepandemic periods, driven by fewer people switching jobs. Among those who switched jobs, we found that workers during the pandemic were more likely to stay in a health care industry relative to prepandemic. We found no evidence that wage support policies influenced direct care worker exits during or after the pandemic.

Conclusions And Implications: Our findings suggest that broader economic trends of a shrinking workforce may be the primary driver of direct care worker exits during the pandemic.