A new study by researchers at the University of Minnesota finds that low-wage healthcare workers are leaving the profession at higher rates than before the pandemic, resulting in labor shortages and heavy workloads that are affecting the quality of care.
Healthcare workers such as nursing assistants, home and personal care aides provide essential hands-on care for older and disabled people. They have been on the front lines of caring for COVID-19 patients and patients at high risk of COVID mortality, often without adequate personal protective equipment.
Women, especially women of color, are overrepresented among direct care workers and are deeply impacted by the crises facing this workforce. And despite the crucial nature of this work, the pay is poor.
New research by the Center on Women, Gender, and Public Policy at the University of Minnesota’s Humphrey School of Public Affairs, along with faculty from the University’s School of Public Health and Department of Sociology, shows the pandemic has laid bare the crushing working conditions, dismal wages, and physical risks of direct care work in the healthcare sector. As a result, many have decided to leave the profession, which is leading to more significant labor shortages.
• Minnesota nursing homes experienced the largest staffing shortages in the country this year. According to an analysis of federal data, 41 percent of the state’s long-term care facilities reported shortages of nurses, aides, clinical staff, and other support staff – up substantially from pre-pandemic rates. The risk of infection, loss of child care, and increasing workloads prompted workers to seek alternative employment.
• Women make up 85 percent of the low-wage healthcare workforce in Minnesota, and more than one-third of them are people of color. These workers do not make a living wage. In 2020, the average wage for direct care workers in Minnesota was $14.72 per hour, far less than the estimated living wage in Hennepin County for one adult with no children of $18.74.
• About 40 percent of direct care workers in Minnesota have insurance through Medicaid, Medicare, or another public source.
• Nationally, 6.5 percent of direct healthcare workers left the labor market in 2021, a 30 percent increase from pre-pandemic exit rates. Nationally, 40 percent of direct care workers transitioned to another occupation between January 2019 and December 2021.
“Low wages and few opportunities for advancement make it difficult for these workers to stay in the labor force,” said Professor Christina Ewig, director of the Center on Women, Gender, and Public Policy. “Those circumstances make it more likely that these workers will transition to other occupations where such opportunities exist.”
Interviews with Minnesota healthcare workers confirmed these sentiments. Many said that because their workloads have increased due to the labor shortage, they no longer have time to engage in meaningful aspects of their work, such as building relationships with patients.
Said one worker: “It’s gotten more difficult throughout the pandemic because there’s less staffing … and you have to do more tasks for more people.”
The report recommends swift action by policymakers to attract and sustain direct care workers in this critical sector, to raise wages, and to create greater opportunities for advancement without further burdening workers.
• Redistribute Medicaid and Medicare spending. Medicare and Medicaid reimbursement policies promote wage inequality within healthcare. Nationally, the Centers for Medicare and Medicaid Services must develop a plan for how to redistribute funds to promote higher wages for direct care workers. The Minnesota Legislature should explore how it might ensure that Medicare and Medicaid compensation matches the value of and demand for this workforce.
• Support unionization. Unionization results in higher wages for direct care workers. Federal policymakers should pass the Protecting the Right to Organize (PRO) Act of 2021 to promote greater unionization. In Minnesota, policymakers should collaborate with worker and provider organizations to build support for legislation to increase compensation rates.
• Avoid additional training and licensure requirements. Adding such requirements further disadvantages workers of color. Research shows that female and direct care workers of color do not receive the same rewards from additional certification requirements.
“The pandemic is an urgent call to build resilience in this essential workforce by reforming state and federal policy priorities,” said Janette Dill, associate professor in the School of Public Health and the lead author of the report. “Investing in the care infrastructure and in direct care work improves the lives of both the women that provide this needed care and the patients they serve.”