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New Study on State Hazard Pay and Sick Leave Policies for Direct Care Workers During COVID-19

July 12, 2022

NEW YORK — In the first 18 months of the COVID-19 pandemic, 17 states implemented at least one hazard pay policy and four states implemented a new paid sick leave policy that supported direct care workers through the COVID-19 pandemic, according to a new research report from PHI, a New York-based national organization focused on strengthening the direct care workforce through research, advocacy, and workforce innovation.

According to the research report, while 24 states and the District of Columbia (DC) supported direct care workers with hazard pay and/or paid sick leave policies during the first 18 months of COVID-19, 26 states had or did nothing in this regard.

The research report—Essential Support: State Hazard Pay and Sick Leave Policies for Direct Care Workers During COVID-19—details findings from a recent study by PHI on hazard pay and paid sick leave policies enacted across all 50 states and DC from March 2020 to August 2021.

The purpose of the study was to document how states responded to the challenges faced by direct care workers and other essential workers during one of the most devastating health crises in recent history—and to generate lessons for the future.

“While direct care workers have been considered ‘essential’ throughout the pandemic, our research report demonstrates that states varied significantly in how they supported this workforce through hazard pay and paid sick leave policies,” said Jodi M. Sturgeon, president at PHI.

“To properly navigate this and future health crises, states must transform the direct care job, which includes offering better compensation and benefits to these workers,” added Sturgeon.


According to the research report, 17 states implemented at least one hazard pay policy in the studied period, including Arkansas, California, Connecticut, Illinois, Louisiana, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, and Washington State.

Among these states, six implemented a one-time bonus payment, ranging from $250 to just over $2,200, while 11 implemented hourly wage increases or weekly bonuses, ranging from $2 to $5 and $100 to $500, respectively.

Many of these hourly or weekly increases were in place for no more than three months.

“Hazard pay is an essential tool for supporting and stabilizing the direct care workforce during a crisis, yet our research shows that many states offered too little or nothing at all in this regard during the first waves of the pandemic,” said Dr. Kezia Scales, senior director of policy research at PHI and one of two authors of the research report.

The study also closely examined how Michigan’s hazard pay policy—the most generous and sustained example across all states—affected direct care workers’ economic stability, finding that it increased home care workers’ hourly wages and weekly earnings by $2.43 and nearly $90, respectively, but had no effect on the wages and earnings of nursing assistants in nursing homes. The latter result raises questions about the implementation and enforcement of the policy in nursing homes.


The study also found that four states—Colorado, New Mexico, New York, and Virginia—implemented a new paid sick leave policy during the study period. In addition, of the 14 states that already had an existing paid sick leave or general leave policy in place before the COVID-19 pandemic, four made amendments or issued supplementary policies.

According to the research report, most states with existing paid sick leave policies issued guidance specific to COVID-19 early in the pandemic period. Among states that amended their paid sick leave policies or enacted new policies, however, the timeline varied considerably—from as early as March 1, 2020, to as late as July 1, 2021.

The study also showed that a similar proportion of direct care workers took time off in states that implemented paid sick leave policies before or during the pandemic period as in states that did not, which suggests that paid sick leave policies did not affect the likelihood of being absent from work.

“Paid sick leave can support the health of direct care workers and ensure they have the time to recover from illness to deliver quality care safely, yet paid sick leave coverage across states remains limited, and is completely absent at the federal level,” said Stephen McCall, data and policy analyst at PHI and the other co-author of the research report.

The study also found that only 10 states implemented both hazard pay and paid sick leave policies: California, Connecticut, Massachusetts, Michigan, New Jersey, Oregon, Rhode Island, Vermont, Virginia, and Washington State.

Conversely, 26 states neither implemented nor had an existing hazard pay or paid leave policy, including Alabama, Alaska, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia, Wisconsin, and Wyoming.


The research report offers a slate of lessons learned related to improving direct care jobs and stabilizing the long-term services and supports system, including: extending these types of supportive policies across direct care occupations and settings, sustaining short-term wage increases by permanently raising the wage floor for this workforce, and developing a national compensation strategy for direct care workers that creates a livable, competitive wage for direct care workers.

Other lessons learned cited in the research report include establishing permanent paid sick leave laws, incorporating supplemental public health emergency clauses into paid sick leave laws, creating a state or regional paid care advocate, and evaluating the implementation and impact of direct care workforce-related policies.

“The COVID-19 pandemic has created an unprecedented opportunity to reimagine and invest in policies that strengthen the direct care workforce, but we must all act now,” said Scales.

This research report was made possible by generous funding from the Ralph C. Wilson, Jr. Foundation.

To read the full research report, which includes a comprehensive catalogue of states’ hazard paid and paid sick leave policies impacting the direct care workforce, click here.


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