BackHome
Refresh: Off
Session Submission Summary
Share...

Direct link:

The Direct Care Workforce: Recruitment, Retention, and Labor Market Dynamics

Thursday, November 5, 3:30 to 5:00pm, Property: Boston Marriott Copley Place, Floor: 1st Floor/Lobby Level, Room: Boylston

Session Submission Type: Panel

Abstract

The United States faces a growing crisis in long-term care staffing. Nursing homes and home health agencies struggle with persistent worker shortages and high turnover, with negative consequences for the millions of older adults who rely on these services. Population aging will only intensify demand for direct care workers in the coming decades, making it essential to understand the factors that shape recruitment, retention, and labor market mobility in this sector. This panel brings together four papers that examine the direct care workforce from complementary angles, combining novel data sources and varied methodological approaches to inform policy efforts aimed at strengthening the long-term care labor force.The first paper examines modifiable organizational factors that may improve workforce stability in dementia care settings. Using data from the National Dementia Workforce Study linked to facility and county characteristics, the authors construct composite measures of scheduling practices, training, and benefits, and estimate their associations with job retention across staff roles in nursing homes and assisted living communities. The findings suggest that scheduling stability and comprehensive benefits may improve retention among registered nurses in nursing homes, though effects vary across roles and settings.The second paper evaluates a wage pass-through reform in Illinois that provided experience-based subsidies to certified nursing assistants in nursing homes. Combining administrative earnings records with shift-level timesheet data, the authors compare staffing patterns in adopting and non-adopting facilities before and after the reform. Preliminary findings indicate that the payments increased staffing in the medium term, driven by increased hiring, with effects concentrated in facilities serving a large share of Medicaid residents.The third paper uses the longitudinal structure of the Current Population Survey to track year-over-year transitions into, out of, and within nursing home CNA roles from 2010 through 2025. The authors find that turnover among nursing home CNAs is high even relative to other low-wage sectors, with only 46 percent remaining in the role 12 months later. Workers who leave experience meaningful improvements in wages and benefits, highlighting the competitive disadvantage nursing homes face in retaining direct care staff.The fourth paper examines work-related travel among home care workers, with a focus on how transportation barriers differ by immigration status. Using American Community Survey data, the authors document that immigrant home care workers, particularly those who are likely undocumented, are significantly less likely to drive to work and less likely to have a car available, suggesting that transportation access may limit workforce participation among a population that comprises more than a third of home care workers.Together, these papers advance our understanding of the direct care labor market by examining workplace conditions, wage policies, worker mobility, and structural barriers to employment. The findings have direct implications for federal and state policies aimed at improving staffing levels, reducing turnover, and ensuring an adequate supply of workers to meet the long-term care needs of an aging population.

Policy Area

Chair

Discussant

Organizer

Individual Presentations