Post-It note with "now hiring" written on it

Poor job quality and low wages are the top reasons COVID-displaced workers have shied away from direct care job openings, despite having similar skill sets, according to a new report.

Despite a new labor pool of 13.7 million U.S. workers displaced from their jobs during the first three months of the pandemic in 2020, an “immeasurably small number” of them entered the direct care workforce, researchers found. Many long-term care operators continue to face staff shortages, leading to a curtailment of services in some cases. 

A new study from New York-based PHI and the Health Workforce Research Center on Long-Term Care at the University of California, San Francisco, lays out several recommendations to address widespread recruitment and retention challenges for direct care workers. 

Long-term care employers will need to fill 7.4 million job openings in direct care through 2029, according to the report. This amount includes the creation of 1.3 million new jobs to meet rising demand and another 6.1 million job openings to replace workers who leave the workforce to seek employment in new sectors that offer higher wages or safer working conditions.

To tap into a new labor pool of millions of workers displaced from their jobs by the pandemic, the authors recommend that operators raise wages, target recruitment, provide workforce supports, create smoother transitions into the sector and improve overall job quality.

The study examined workforce displacement and re-entry during the pandemic. Researchers specifically focused on whether and how new workers were recruited into direct care jobs as residential and personal care aides, nursing assistants and home health aides, from occupations with similar skill sets, including food preparation and service, and office and administrative support.

“The fact that few workers who lost jobs during the pandemic moved into open direct care jobs highlights the need to improve direct care jobs so they attract well-skilled and dedicated people to care for people who need their services,” said Joanne Spetz, Ph.D., associate director for research at the Health Workforce Research Center on Long-Term Care at the University of California, San Francisco, and one of the report’s co-authors.

Two-thirds (67%) of the 13.7 million displaced workers (9.2 million workers) were in five major occupational groups: food preparation and serving (3.1 million workers), office and administrative support (2 million), sales (1.6 million), transportation and material moving (1.6 million) and production (1 million).

By early 2021, 66% of COVID-displace workers (9.1 million) had re-entered the workforce, leaving 4.6 million still out of work. Workers in two occupational groups similar to direct care had large numbers of workers who did not re-enter the workforce — food service and serving (1.9 million displaced workers) and office and administrative (1.2 million displaced workers). 

A small percentage of direct care workers (4%) were displaced during the second quarter of 2020, and an even smaller number of workers were re-employed into direct care jobs. 

“The overarching lesson from this report is our country’s leaders will need to transform the direct care workforce to ensure that employers can fill these jobs — now and in the decade ahead,” said Kezia Scales, PHI director of policy research and one of the report’s co-authors.

Possible solutions

The authors cited several opportunities to strengthen the direct care workforce:

  • Improve wages and benefits through a combination of changes in Medicaid policy and employer practices.
  • Develop tailored recruitment messages to effectively reach workers displaced from other occupations, including highlighting shared job characteristics, a priority on teamwork and the intrinsic value of caring for others.
  • Develop recruitment strategies and employment supports for specific populations, including race-explicit workforce supports, assistance with affordable childcare and other long-term services and supports. 

“Overall, this research underscores the urgent need to build robust recruitment pipelines into the long-term care field and to make meaningful, lasting improvement in job quality for direct care workers,” the authors concluded. 

The study was supported by a $450,000 award from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.