Contingent Workers in Long-Term Care

Background: In a recent study of the “gig economy,” or alternative work arrangement (e.g., self-employed, freelancers, on-call, temporary workers, and contract labor), healthcare was one of two industries (the other being education) that experienced the fastest growth of gig workers over the last decade. The use of gig workers is not new in the long-term care (LTC) sector where skilled nursing facilities and home health agencies primarily use contract workers to fill temporary gaps where traditional workers are unavailable or where patient census fluctuates. There are concerns that companies are increasingly using gig workers as a permanent staffing solution and cost-cutting strategy by avoiding payment of benefits such as health insurance and retirement. Gig workers may like the flexible hours of this work, but these jobs may not provide stable and predictable earnings with benefits.

Objective: This study investigates which LTC occupations are most often involved in gig work, and how workers in gig versus traditional work arrangements vary with regards to sociodemographic characteristics, occupation/industry transition (exit or entry) rates, and wage rates.

Methods: We use data from the Current Population Survey’s Annual Social and Economic Supplement (ASEC) and the Continent Workforce Supplement (CWS) conducted in 1995, 2005, and currently fielded in 2017. We use probit models to identify the sociodemographic characteristics that predict the probability of being a gig worker. We create categories of leavers, stayers and entrants based on questions about the occupation and industry the individual worked in the current and prior year. We use probit models to examine whether the probability of entry/exit within an occupation/industry is associated with being in gig worker. We use generalized linear models with gamma distribution and log link to examine how wage rates vary between those in gig versus traditional work, controlling for sociodemographic characteristics. Survey weights are used in all analyses.

Results: Of the approximately 17 million workers in healthcare, 6.0% reported being self-employed, one form of gig-work, in 2016. The five most common occupations where individuals reported being self-employed include (most to least frequent): massage therapists, physical therapists, home/personal care aides (HCAs), home health aides (HHAs), and social workers. Focusing on the most vulnerable LTC occupations, 11% of HHA and 11% of HCAs were self-employed. HHAs with any child in the household or age 35 to 44 were significantly less likely to be self-employed than employed. HCAs living in age 55 to 64 were significantly more likely to be self-employed than employed. Transition rates were not significantly different between gig and traditional workers. Average individual annual wages for HHAs were marginally significantly lower for those self-employed versus employed, though not significantly different for HCAs. Additional forms of gig work using results from the CWS, along with time trends will be presented.

Conclusion: LTC workers are in a financially vulnerable position though the impact of gig arrangements is mixed. Without adequate financial compensation, healthcare workers are more likely to leave their jobs. Turnover among healthcare workers is disruptive to the continuity and quality of healthcare delivery.