Nursing Home Aides, Assistants See Highest Job Turnover During Covid

Approximately 1.5 million health care workers lost their jobs during the early days of the pandemic, when surgeries were postponed and some facilities temporarily closed their doors. While most of those jobs returned by the fall of 2020, health care employment remained 2.7% lower than pre-pandemic levels as of November 2021.

As many in the health care sector are on track to rebound from high turnover rates, long-term care workers are not among them.

That’s according to a study published on Friday in JAMA Health Forum that explored turnover among health care workers during the COVID-19 pandemic.

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“We found that turnover rates in long-term care have been not only increasing during the pandemic, but they were higher even before the pandemic,” University of Washington Professor and study author Bianca Frogner told Skilled Nursing News.

The study used data from 125,717 health care workers, comparing turnover rates before the pandemic (January 2019 to March 2020) with the first nine months of the pandemic (April 2020 to December 2020) and the latter eight months (January 2021 to October 2021).

Before Covid, an average of 3.2% of health care workers reported turnover. During the early days of the pandemic, of which the study refers to as post period 1, 5.6% of health care workers reported turnover and in the final reporting period 5.6% of workers reported turnover, the study found.

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Turnover rates were highest in the April 2020 to December 2020 timeframe – with the exception of long-term care workers and physicians.

Turnover rates varied widely across depending on the health care position. There was a nearly four-fold difference between aides and assistants, jobs associated with lower wages, and physicians – those who generally see higher pay.

Health aides and assistants saw the highest turnover rates during this timeframe, according to the study.

Part of the problem is that some assistant and aide roles do not offer paid sick time or adequate childcare if they do, leaving workers to choose between staying employed or caring for their personal health and the health of their families, the study noted.

Women in health care were consistently more likely to experience job turnover compared with men across all time periods, and health care workers with young children were more likely to leave their jobs.

“I think long-term care is not a well paid industry and because it has a complicated reimbursement system, individuals who are in these aides and assistant positions have long been known to have very low pay,” Frogner told SNN.

She said one of the reasons job turnover is considerably worse for long-term care providers could be due to competition with hospitals and other health care settings.

“[Long-term care providers] have not had the same kind of resources at their disposal to be able to increase wages as they need to or provide the benefits to make these attractive places for people to work,” Frogner said. “So we are losing workers, oftentimes to other industries, who may be more flexible to increase wages or other benefits because they can pass the cost on to the consumer.”

In some of the other settings as well, like ambulatory, early pandemic shutdowns were partly responsible for spikes in turnover rates as many clinics closed temporarily because of furloughs.

Frogner remains hopeful that with the release of the National Academies of Sciences, Engineering and Medicine report on improving nursing home quality, and Biden’s recently unveiled nursing home reform package, that more national attention has been brought to the industry.

“Now is the time that we can have a real conversation about how to improve our nursing homes and focus on and invest in its workforce,” she said.

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