Could COVID-Displaced Workers Help Fill Job Openings in Direct Care?

The COVID-19 pandemic has made direct care worker recruitment and retention even more challenging than before the virus emerged, given the heightened risks faced by these workers. However, the pandemic has also presented the long-term care field with an opportunity to grow the direct care workforce, since millions of workers were displaced in early 2020 from occupations with similar entry-level requirements to direct care jobs.

In this context, the key question is: were any of these displaced workers re-employed in direct care jobs to fill acute workforce shortages—or could they be recruited to fill these jobs?

To answer this question, PHI and the Health Workforce Research Center on Long-Term Care at the University of California, San Francisco recently conducted research on workforce displacement and re-entry during the COVID-19 pandemic. Using data from the U.S. Census Bureau’s Current Population Survey, we examined how many and what proportion of workers were displaced from jobs with similar entry-level requirements to direct care during the first wave of the pandemic, and how many of those displaced workers were re-employed in early 2021 (in a direct care job or any other occupation). We also used data from the Occupational Information Network (O*NET) to assess the alignment between displaced workers’ previous positions and direct care jobs (according to knowledge, skills, activities, and work context).

Here are the main findings and lessons from our critical study.

Workforce Displacement

Thirteen point seven million workers in occupations with similar entry-level requirements to direct care were displaced from their jobs in the first three months of the COVID-19 pandemic. This figure includes 3.1 million workers from food preparation and serving-related jobs and 2 million workers from office and administrative support jobs—two occupations with the most overlap with direct care, according to our O*NET analysis. By comparison, 128,830 direct care workers were displaced from their jobs. While this figure appears large, direct care workers were less likely to be displaced than any other occupational group in our study.

This analysis also showed that women and people of color in these occupational groups were disproportionately impacted by the COVID-19 economy. After controlling for other factors like education, region, and occupation, among others, women were four percent more likely than men to be displaced. Compared to white workers, Asian/Pacific Islander workers were seven percent more likely to be displaced, Black/African-American workers were six percent more likely to be displaced, and Hispanic/Latino workers were three percent more likely to be displaced.

Workforce Re-Entry

COVID-19’s effects on employment patterns lessened throughout the first year of this crisis. Across the occupations we studied, most workers (9.1 million) who had been displaced from their jobs in 2020 re-entered the workforce by early 2021. Sixty-two percent of these workers were re-employed into the same occupational group, leaving 38 percent who re-entered new occupations.

However, an immeasurably small number of these displaced workers (from direct care or any other occupation) were re-employed in the direct care workforce—despite the dire need. Wages were likely a contributing factor. Our analysis showed that workers who were re-employed tended to earn higher wages in their new jobs in other occupations than they would have in direct care. Even among the 22 percent of displaced workers who were re-employed into lower-paying occupations (compared to their previous occupations), median hourly wages were still marginally higher ($14.56) compared to median wages for direct care workers in this sample ($14.05).

Low wages and occupational groups did not entirely explain re-employment trends; re-employment trends differed by gender and race. Compared to men, women were six percent less likely to re-enter the workforce after being displaced by COVID-19. Also, re-employment rates were similar among white and Hispanic/Latino workers (71 percent and 69 percent, respectively), but re-employment rates were lower for African/American workers (57 percent) and Asian/Pacific Islander workers (54 percent).

Untapped Potential

This new research shows that the long-term care field has been largely unsuccessful in recruiting displaced workers to direct care during the COVID-19 crisis—but it’s not too late. According to our analysis, 4.3 million displaced workers were still not re-employed in 2021. This figure includes 1.2 million former food preparation and serving workers and over 765,000 workers from office and administrative support occupations. These occupations could possess a range of knowledge, skills, and experience that may be transferable to direct care.

Several strategies could be adopted to tap into this labor pool, starting with higher wages. As employers from other industries (like food service and hospitality) raise wages and offer other incentives to attract displaced workers, direct care wages are falling even further behind. Policymakers at the state and federal levels could respond by increasing public funding for long-term care with provisions that ensure reimbursement rate increases reach direct care workers directly (for example, by adopting wage pass-through provisions). The funding proposals currently under discussion in Congress could provide new opportunities to make these needed investments in the workforce.

Tailored recruitment strategies also could be developed that emphasize similarities between displaced workers’ previous jobs and direct care jobs. As one example, employers and others involved in workforce development could create recruitment messages that appeal to displaced workers’ previous experiences with caregiving, customer service, and teamwork. Another strategy is to strengthen employment supports for direct care workers with unique needs—through race-explicit workforce interventions and by assisting workers with childcare or eldercare responsibilities, among other examples.

Improved job quality, targeted recruitment, and tailored employment supports are essential for strengthening the direct care workforce to meet demand. These strategies won’t just stabilize the direct care workforce through the end of the COVID-19 crisis, they will have a lasting impact on recruitment and retention in the long-term care field.

Read the full research report here.

This project was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $533,932.00, with 0% financed with non-governmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the US Government. For more information, please visit HRSA.gov. Warm thanks to Joanne Spetz, PhD, for her collaboration on this research.