Long-term care employee compensation

Evidence Rating  
Evidence rating: 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.

Health Factors  
Decision Makers
Date last updated

Long-term care employee compensation initiatives 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 with inconsistent hours, and have little opportunity for advancement1, 2.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased retention of long-term care workers

What does the research say about 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)3, 4, 5. Available evidence suggests that increasing wages and other benefits for LTC staff may reduce turnover3, 6, 7, 8, 9, 10, 11, particularly among newly hired or young caregivers6, 12. Providing health insurance may also help employers retain existing staff13, 14 and attract new part-time employees14. However, additional evidence is needed to confirm effects.

Low wages and benefits are consistently cited by LTC workers as a source of stress15, and by researchers as a reason for high turnover3, 16. Studies suggest that higher wages6, 8, 17 and offering more hours to part-time staff13 may positively affect retention of LTC workers.

Research suggests that individuals leave LTC roles for similar positions that provide better wages, full time status2, 10, and reimbursement for travel10. Offering health insurance3, 13, consistent patient assignments13, workplace safety improvements, proper patient care training1, and opportunities for professional development, mentorship, and educational support for career advancement3 may all contribute to higher retention of LTC workers.

How could this strategy impact health disparities? This strategy is rated 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 protections18.

Implementation Resources

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


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1 Butler 2017 - Butler SS. Exploring relationships among occupational safety, job turnover, and age among home care aides in Maine. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy. 2017.

2 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.

3 Frogner 2016 - Frogner BK, Skillman SM, Patterson DG, Snyder CR. Comparing the socioeconomic well-being of workers across healthcare occupations. Center for Health Workforce Studies, University of Washington. 2016.

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

5 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, D.C.: U.S. Department of Health and Human Services (U.S. DHHS); Office of the Assistant for Planning and Evaluation (ASPE), Office of Disability, Aging, and Long-Term Care Policy (DALTCP); 2004.

6 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.

7 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.

8 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.

9 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.

10 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.

11 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.

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

13 Stone 2017 - Stone R, Wilhelm J, Bishop CE, et al. Predictors of intent to leave the job among home health workers: Analysis of the national home health aide survey. The Gerontologist. 2017;57(5):890-899.

14 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.

15 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.

16 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.

17 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.

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