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Long-term care employee compensation

Evidence Rating

Expert Opinion

Health Factors

Increase wages and benefits for personal or home care workers, nurse aides, and others who provide direct care to patients in long-term care (LTC) settings such as nursing homes, rehabilitation facilities, and individual homes. LTC workers typically care for elderly adults, individuals with disabilities, or individuals recovering from injuries; hands-on, physically demanding care is often needed. Many workers are employed part-time and have little opportunity for advancement (US DHHS-LTC 2003, US DHHS-Raynor 2003).

Expected Beneficial Outcomes (Rated)

  • Increased retention of long-term care workers

Evidence of Effectiveness

Offering higher wages and more comprehensive benefits is a suggested strategy to improve recruitment and retention of individuals that provide long-term care (LTC) (CWF-Raphael 2008, US DHHS-Fishman 2004). Available evidence suggests that increasing wages and other benefits for LTC staff may reduce turnover (, Hewko 2015, , , , Wiener 2009), particularly among newly hired or young caregivers (, ). Providing health insurance for part-time workers may also help employers retain existing staff and attract new employees (). However, additional evidence is needed to confirm effects.

Low wages and benefits are consistently cited by LTC workers as a source of stress (), and by researchers as a reason for high turnover (Stone 2012, US DHHS-LTC 2003, US DHHS-Raynor 2003). Studies suggest that higher wages may positively affect retention of LTC staff (, , ).

Research suggests that individuals leave LTC roles for similar positions that provide better wages, full time status (, ), and reimbursement for travel ().

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of January 2015, direct care workers such as home health aides, personal care aides, and certified nursing assistants employed by home care agencies and other third party employers are covered by the Fair Labor Standards Act’s minimum wage and overtime protections (US DOL-Direct care wage).

Implementation Resources

US DOL-Direct care - US Department of Labor (US DOL). Wage and Hour Division. We count on home care: Minimum wage and overtime pay for direct care workers.

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.

Morgan 2013* - Morgan JC, Dill J, Kalleberg AL. The quality of healthcare jobs: Can intrinsic rewards compensate for low extrinsic rewards? Work, Employment & Society. 2013;27(5):802–822.

Head 2013b* - Head BA, Washington KT, Myers J. Job satisfaction, intent to stay, and recommended job improvements: The palliative nursing assistant speaks. Journal of Palliative Medicine. 2013;16(11):1356–1361.

Butler 2014* - Butler SS, Brennan-Ing M, Wardamasky S, Ashley A. Determinants of longer job tenure among home care aides: What makes some stay on the job while others leave? Journal of Applied Gerontology. 2014;33(2):164–188.

Hewko 2015 - Hewko SJ, Cooper SL, Huynh H, et al. Invisible no more: A scoping review of the health care aide workforce literature. BMC Nursing. 2015;14(38):1–17.

Banijamali 2014* - Banijamali S, Jacoby D, Hagopian A. Characteristics of home care workers who leave their jobs: A cross-sectional study of job satisfaction and turnover in Washington State. Home Health Care Services Quarterly. 2014;33(3):137–158.

Citations - Implementation Examples

* Journal subscription may be required for access.

US DOL-Direct care wage - US Department of Labor (US DOL). Minimum wage, overtime protections extended to direct care workers by US Labor Department.

Date Last Updated

Jul 28, 2016