In early 2020, just under 170,000 direct care workers were displaced from their jobs—along with 13.7 million workers who were displaced from other occupations with similarly low entry-level requirements (like food service, retail and administrative occupations). However, an immeasurably small number of displaced workers from direct care or any other occupation were re-employed in the direct care workforce. What this means is that, during the first year of the COVID-19 pandemic, despite a pressing workforce crisis, the long-term care field lost a substantial number of direct care workers.
Those findings come from a recent study conducted by PHI and the University of California San Francisco (UCSF) Health Workforce Research Center on Long-Term Care. Using data from the U.S. Census Bureau’s Current Population Survey, the study describes how many workers from occupations similar to direct care (based upon requirements for education, training and experience) were displaced from their jobs in the first three months of the COVID-19 pandemic, and how many were re-employed by early 2021.
While the findings raise concerns about direct care workforce stability, this study highlights clear opportunities for long-term care leaders to take action. Out of those 13.7 million displaced workers, 9.1 million were re-employed one year later, leaving 4.6 million workers who remained out of the workforce by spring 2021. A substantial proportion of the remaining displaced workers (60 percent) are not looking for jobs, including 84 percent of displaced direct care workers, but that does not mean they are unwilling to return to the workforce. Many displaced workers, regardless of their labor force participation, could be successfully recruited into the direct care workforce through the right policy and practice interventions.
Improving Wages
First, to bring back former direct care workers and recruit other displaced workers to the field, employers and policymakers must make direct care jobs more financially viable. The PHI and UCSF study found that displaced workers were mostly re-employed in occupations with median wages that were higher than the median wage for direct care (which was $14.05 per hour in this study sample). Even for those workers who moved into a lower-wage occupation (compared to their original occupation), median wages ($14.56 per hour) were still higher than the median wage for direct care.
State leaders and employers should work together to reach displaced workers through targeted recruitment campaigns.
The bottom line is direct care wages are not competitive. Recently, employers across sectors, such as food service and hospitality, have raised wages to attract displaced workers. Long-term care employers have been left behind, largely because their ability to invest in wages hinges upon higher reimbursement rates from public programs (like Medicaid and Medicare) that remain woefully underfunded.
The federal government has made additional funding available for states to invest in the direct care workforce through the American Rescue Plan Act, and more federal funding could be coming soon from the Biden administration’s Build Back Better plan. To attract displaced workers into these jobs, state leaders must ensure that some of this enhanced funding goes toward increasing direct care workers’ wages. Employers can take other steps to improve their workers’ total compensation as well, for example by offering paid leave, health insurance or other benefits.
Attracting Displaced Workers with the Right Messages
As well as improving direct care job quality, employers and state leaders should work together to reach displaced workers through targeted recruitment campaigns. For example, according to the PHI and UCSF study, 3.1 million workers were displaced in the early months of the COVID-19 pandemic from two occupations that share many similar job characteristics with direct care jobs—food service and administrative support occupations. Recruitment campaigns tailored to these groups of displaced workers could appeal to their skills and previous work experience, like teamwork and customer service.
Addressing Racial and Gender Disparities
This research also highlights the need to consider gender and race in recruitment and retention efforts, as women and people of color in the study sample were more likely to be displaced and less likely to be re-employed than white and male workers.
First, women were 4 percent more likely to be displaced than men and 6 percent less likely to be re-employed (even after controlling for occupation and other factors)—probably because women have borne the brunt of increased childcare and other family caregiving responsibilities during (and before) the COVID-19 pandemic. Strengthening caregiving support and services would support women in particular who were displaced from their jobs during the pandemic.
‘Race-explicit strategies could help recruit and retain displaced workers of color in the direct care workforce.’
Among people of color, Asian/Pacific Islander workers were 9 percent more likely to be displaced than white workers, Black/African American workers were 7 percent more likely to be displaced and Hispanic/Latino workers were 6 percent more like to be displaced. Black/African American and Asian/Pacific Islander workers were also less likely to re-enter the workforce. Occupational segregation and employment discrimination by race both likely influenced these disparities.
Race-explicit strategies could help recruit and retain displaced workers of color in the direct care workforce. As one example, employers could focus on increasing diversity at every level of their organization and training all staff on how to address personal biases and other inequities within their organizations that are rooted in systemic racism, among other forces. State leaders also can play a role in bolstering employers’ capacity to adopt these practices by hosting events, funding and disseminating resources and convening peer learning networks that guide employers on how to address racial inequities within long-term care settings, to name a few examples.
Urgent Action Is Needed
For years, long-term care employers have faced high workforce turnover and struggled to fill vacant positions—and the COVID-19 pandemic has greatly intensified these challenges. The pandemic also has created a labor pool of millions of displaced workers who could help strengthen and stabilize the direct care workforce. Although these displaced workers have not yet been re-employed in long-term care, it’s not too late. The interventions described above (and elaborated in our joint research report) could help to immediately address the direct care workforce shortage and make a lasting impact on the field.
Stephen McCall, MPA, is the data and policy analyst at PHI in the Bronx, NY.
