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Increase wages & benefits for long-term care (LTC) workers

Evidence Rating

Scientifically Supported

Health Factors

Long-term care (LTC) workers provide care to clients in a variety of settings, such as in-home care, nursing homes, and rehabilitation facilities. Patients are generally the elderly, individuals with disabilities, or recovering from injuries; hands-on, physically demanding care is often needed. Direct care work is usually provided by personal care workers, home care workers, and nurse aides. Many workers are employed part-time (US DHHS-Raynor 2003) and have little opportunity for advancement (US DHHS-LTC 2003, US DHHS-Raynor 2003).

Expected Beneficial Outcomes

  • Increased retention of direct care workers

  • Increased number of direct care workers

Evidence of Effectiveness

There is strong evidence that increasing wages and benefits for long-term care workers increases the size and stability of the direct care workforce (, , , ). Offering better wages and benefits is a suggested strategy to improve recruitment and retention of individuals that provide long-term care (CWF-Raphael 2008, US DHHS-Fishman 2004).

Increasing the wages and other benefits available to long-term care workers reduces turnover (, , Wiener 2009), particularly among newly hired caregivers (). Providing health insurance for part-time workers can both attract new employees and help employers maintain existing workers ().

Research suggests that workers leave homecare positions for similar positions that provide better wages, increased hours, and reimbursement for travel (). Low wages and benefits are consistently cited by workers as a major source of stress (), and by researchers as a reason for high turnover and job instability in the field (Stone 2012, US DHHS-LTC 2003, US DHHS-Raynor 2003).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

The Affordable Care Act (ACA) included provisions to increase wages and benefits for direct care workers, but as of April 2012, these provisions had not yet received funding (Stone 2012).

Citations - Evidence

* Journal subscription may be required for access.

US DHHS-Fishman 2004 - Fishman MF, Barnow B, Glosser A, Gardiner K. Recruiting and retaining a quality paraprofessional long-term care workforce: Building collaboratives with the nation’s workforce investment system. Washington, DC: US Department of Health and Human Services (US DHHS); Office of the Assistant for Planning and Evaluation (ASPE), Office of Disability, Aging, and Long-Term Care Policy (DALTCP); 2004.

Howes 2005* - Howes C. Living wages and retention of Homecare workers in San Francisco. Industrial Relations. 2005;44(1):139-63.

Howes 2008* - Howes C. Love, money, or flexibility: What motivates people to work in consumer-directed home care? The Gerontologist. 2008;48(Suppl 1):46-60.

Lapane 2007* - Lapane KL, Hughes CM. Considering the employee point of view: Perceptions of job satisfaction and stress among nursing staff in nursing homes. Journal of the American Medical Directors Association. 2007;8(1):8–13.

Morris 2009* - Morris L. Quits and job changes among home care workers in Maine: The role of wages, hours, and benefits. The Gerontologist. 2009;49(5):635–50.

US DHHS-LTC 2003 - Office of the Assistant Secretary for Planning and Evaluation (ASPE), Centers of Medicare Services (CMS), Health Resource and Services Administration (HRSA), Department of Labor's Office of the Assistant Secretary for Policy, Bureau of Labor Statistics (BLS), Employment and Training Administration (ETA). The future supply of long-term care workers in relation to the aging baby boom generation: Report to Congress. Washington, DC: US Department of Health and Human Services (DHHS); 2003.

Powers 2010* - Powers ET, Powers NJ. Causes of caregiver turnover and the potential effectiveness of wage subsidies for solving the long-term care workforce ’crisis’. B.E. Journal of Economic Analysis & Policy. 2010;10(1): Article 5.

CWF-Raphael 2008 - Raphael C. Long-term care: Preparing for the next generation. New York: The Commonwealth Fund (CWF); 2008.

US DHHS-Raynor 2003 - Raynor CR. Federal workforce development programs: New opportunity for recruiting and retaining direct care workers in the long-term care field. Washington, DC: US Department of Health and Human Services (US DHHS); 2003.

Stone 2012 - Stone RI, Bryant N. The impact of health care reform on the workforce caring for older adults. Journal of Aging & Social Policy. 2012;24(2):188–205.

Wiener 2009 - Wiener JM, Squillace MR, Anderson WL, Khatutsky G. Why do they stay? Job tenure among certified nursing assistants in nursing homes. The Gerontologist. 2009;49(2):198–210.

Citations - Implementation Examples

* Journal subscription may be required for access.

Stone 2012 - Stone RI, Bryant N. The impact of health care reform on the workforce caring for older adults. Journal of Aging & Social Policy. 2012;24(2):188–205.

Date Last Updated

May 23, 2013
  • Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
  • Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
  • Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
  • Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
  • Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
  • Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results.