Employment Transitions of Direct Care Workers: The Role of Wages

Adequate staffing of direct care workers in both health care and long-term care settings remains an important policy issue, as health care demand remains high and demand for long-term care will increase as the U.S. population ages. However, adequate staffing is a concern. The direct care workforce is made up of low-skill workers who tend to move frequently between jobs, both within the health care sector and outside it in other low-wage occupations, including retail sales and fast food. There are a number of factors that are likely to contribute to high rates of job transition. In addition to economic concerns about hours, schedules and wages, these workers have very high rates of workplace injury and emotional burnout. In order to examine these issues, I use data from the 2008 Survey of Income and Program Participation, which records employment status for respondents in each month between 2008 and 2012. These data are uniquely suited to studying workers who may experience more than one job change within a year. The first part of this paper is a descriptive analysis of the extent to which direct care workers transition between health/long-term care jobs and jobs outside those sectors. The second part is a formal model that identifies the causal effect of wages and health insurance on transitions, particular those in and out of care jobs.