从养老院到居家护理：审视新冠疫情对直接护理工作者职业转变的影响。

From Nursing Homes to Home Care: Examining the Impact of the COVID-19 Pandemic on Direct Care Worker Transitions.

作者信息

Miller Katherine E M, Yang Yang, Ballreich Jeromie, Shen Karen

机构信息

Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Roger and Flo Lipitz Center to Advance Policy in Aging and Disability, Johns Hopkins University, Baltimore, MD, USA.

出版信息

J Am Med Dir Assoc. 2025 Jun 13:105717. doi: 10.1016/j.jamda.2025.105717.

DOI:10.1016/j.jamda.2025.105717

PMID:40523645

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12408099/

Abstract

OBJECTIVES

Due to poor working conditions and low wages, workforce turnover in the long-term care industry has been a longstanding issue. Increased risks to workers caused by the COVID-19 pandemic exacerbated these issues. Thus, many states offered wage supports (eg, hazard pay) to try to stabilize the workforce. Our objective was to examine how exits of direct care workers employed in the long-term care industry changed during the COVID-19 pandemic, and whether hazard pay policies mediated the impact of the pandemic on worker exits.

DESIGN

We used the Annual Social and Economic Supplement to identify direct care workers and PHI reports to identify states offering hazard pay during the pandemic.

SETTING AND PARTICIPANTS

The analytical sample consisted of 8164 direct care workers employed in long-term care between 2016-2018 and 2020-2022 in 2 settings: (1) home settings and (2) residential care settings (nursing homes and assisted living).

METHODS

We decomposed direct care worker exits using the Annual Social and Economic Supplement survey responses to (1) unemployment or exiting the labor force, (2) a different health care job or industry, and (3) non-healthcare job (eg, retail). We compared the rates of these components for direct care workers prepandemic (2016-2019) and during the pandemic (2020-2023), and the association of these rates with state wage-support policies.

RESULTS

Direct care worker exits were highest in 2020, with most workers becoming unemployed or leaving the labor force. In 2021-2022, worker exits decreased relative to prepandemic periods, driven by fewer people switching jobs. Among those who switched jobs, we found that workers during the pandemic were more likely to stay in a health care industry relative to prepandemic. We found no evidence that wage support policies influenced direct care worker exits during or after the pandemic.

CONCLUSIONS AND IMPLICATIONS

Our findings suggest that broader economic trends of a shrinking workforce may be the primary driver of direct care worker exits during the pandemic.

摘要

目标

由于工作条件恶劣和工资水平低，长期护理行业的劳动力流动一直是个长期存在的问题。新冠疫情给工人带来的风险增加，加剧了这些问题。因此，许多州提供了工资支持（如危险津贴），试图稳定劳动力队伍。我们的目标是研究在新冠疫情期间，长期护理行业直接护理工人的离职情况如何变化，以及危险津贴政策是否调节了疫情对工人离职的影响。

设计

我们利用年度社会和经济补充调查来识别直接护理工人，并利用个人健康保险（PHI）报告来识别疫情期间提供危险津贴的州。

背景与参与者

分析样本包括2016 - 2018年以及2020 - 2022年期间在两种环境中受雇于长期护理行业的8164名直接护理工人：（1）家庭环境；（2）住宿护理环境（养老院和辅助生活设施）。

方法

我们利用年度社会和经济补充调查的回复，将直接护理工人的离职情况分解为：（1）失业或退出劳动力市场；（2）转至不同的医疗保健工作或行业；（3）非医疗保健工作（如零售）。我们比较了疫情前（2016 - 2019年）和疫情期间（2020 - 2023年）直接护理工人这些构成部分的比率，以及这些比率与州工资支持政策的关联。

结果

2020年直接护理工人的离职率最高，大多数工人失业或退出劳动力市场。在2021 - 2022年，相对于疫情前时期，工人离职率下降，这是由于换工作的人数减少。在那些换工作的人中，我们发现疫情期间的工人相对于疫情前更有可能留在医疗保健行业。我们没有发现证据表明工资支持政策在疫情期间或之后影响了直接护理工人的离职情况。