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Will COVID-19 Change Direct Care Employment? New Data Offer Clues.

April 12, 2021

In September 2020, the Bureau of Labor Statistics (BLS) released new employment projections—and once again, the outlook on the direct care workforce is daunting.

From 2019 to 2029, this workforce is projected to add nearly 1.3 million new direct care jobs, including one million home care jobs, 163,000 residential care jobs, and 119,000 direct care jobs in other industries, like hospitals, vocational rehabilitation services, and more. This dramatic workforce growth will be offset slightly by the loss of 10,000 nursing assistant jobs in nursing homes.

While the projected number of new jobs is astoundingly high, these figures alone offer an incomplete picture of the nation’s full direct care workforce needs. The long-term care sector will also need to fill an additional 6.2 million direct care job openings between 2019 and 2029 as workers leave the field for a new occupation or leave the labor force altogether due to retirement, disability, or some other reason. Combining these departures and new jobs, there will be a projected 7.4 million total direct care job openings in the decade ahead. (See Figure 1.)


However, the data behind these projections were collected well before the COVID-19 pandemic. Given its particularly devastating effects across long-term care settings, a pressing question emerges: how has the COVID-19 pandemic impacted future demand for direct care workers? Combining reports from the field with long-term care employment data, we are confident that the pandemic will not diminish the absolute demand for direct care workers in the years ahead. However, we do speculate it will accelerate the shift in demand for these workers away from nursing homes toward home and community-based settings.

Recent employment data helps illustrate how the pandemic may affect future trends in the direct care workforce. According to the BLS, long-term care jobs fell five percent from February to December 2020, which equates to nearly 342,000 jobs lost (see Figure 2). But the data show different employment patterns across long-term care settings: home care employment was just three percent lower in December 2020 than it had been in February 2020, while residential care employment was seven percent lower and nursing home employment was nine percent lower. (To note, these figures include all long-term care employment, and not just direct care jobs.)


Demand for direct care workers will continue to rise in the years ahead: the COVID-19 pandemic has not slowed down the aging of our population or the need for long-term care services. (And it is possible that people who suffer long-term effects from COVID-19 might drive demand even higher.) We anticipate that home care and residential care jobs will soon reach and surpass pre-pandemic levels—as indicated by the sustained growth of both industries and the more recent push toward home-based care (thanks to increased use of telehealth and other home-based models of primary, sub-acute, and post-acute care during the pandemic).

Job losses in nursing homes, in contrast, are likely to continue for two primary reasons. First, nursing home utilization has been decreasing for decades—a trend which sped up in 2020 due to pandemic-related safety and well-being concerns among consumers and their families. These fears were well-grounded: as of March 21 of this year, nearly 840,000 residents have contracted COVID-19 (suspected or confirmed), more than 131,000 have died from the virus, and social isolation has had a devastating impact on many more. Taken together, these factors—namely, the long-standing consumer preference for home care, heightened safety and quality concerns, and the tragic number of resident deaths in the past year—mean we’re unlikely to see a rebound in nursing home utilization and employment, even as the COVID-19 crisis recedes.

Nursing home job losses also reflect a decreasing supply of nursing assistants and other long-term care workers to fill vacant positions. (If a person leaves the industry and their job is not filled by another worker, this event is considered a “job loss” in the BLS data.) Nursing homes have long experienced astronomical turnover rates—a recent study found that median annual turnover among nursing assistants in nursing homes was 99 percent from 2016 to 2019—and have struggled to fill the resulting job vacancies. Just like with nursing home utilization trends, turnover rates have been exacerbated by the COVID-19 pandemic. Nursing assistants have been asked to work long hours in life-threatening conditions, often without hazard pay, paid sick leave, or adequate support. Without significant improvements in job quality for nursing assistants, nursing homes will likely continue to experience job losses as workers opt for higher quality jobs in other industries.


The recent BLS employment projections send a clear message to the long-term care field—millions of direct care jobs will need to be filled in the years ahead, and stronger recruitment pipelines, improved job quality, and a range of workforce interventions are critically needed for the workforce in this sector. While workforce interventions should consider the impact of the COVID-19 pandemic on specific long-term care settings, better direct care jobs in every setting have never been more vital—nor more deserved by workers themselves.

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