Masked home care worker, appearing tired, sits on the steps leading up to a building.

Millions of entry-level workers sidelined during the COVID-19 pandemic snubbed the direct care industry on their return to the labor force. That stunning finding in a study by elder policy group PHI National and the University of California San Francisco underscores the challenges home care agencies face in recruiting staff.

Stephen McCall

“I think for a lot of displaced workers, they saw that these jobs were low-pay, dangerous and extremely hard,” PHI analyst and study co-author Stephen McCall told McKnight’s Home Care Daily Pulse.  “We can’t blame them for not entering the direct care workforce because we have these systemic failures on the part of direct care workers. If we are going to tap into these labor pools, we are going to have to not only ensure they are compensated well, but that they are trained well and supported in the field.”

Culling U.S. Census Bureau data from early 2020 to early 2021, researchers found the pandemic displaced 13.7 million workers in entry-level jobs. They considered workers employed in occupations with similar requirements to direct care, such as food service, sales and transportation. The study found a little more than 9 million of those workers have since found new ones. A little less than half took jobs in their previous occupations and roughly 20% got jobs in new fields. The researchers couldn’t identify any direct care workers who returned to their previous line of work and said an “immeasurably small number of other workers” took jobs in direct care.

The study found women and people of color were among those home care workers most likely to be displaced during the pandemic and not return to their jobs. McCall believes many haven’t come back because they are primary caregivers in their own homes and may have ongoing concerns about the COVID-19 virus. To attract women, especially those of color, McCall said employers need to focus not only on pay, but on transportation assistance, child care assistance and other incentives.

“Adopting practices of diversity, equity and inclusion at an organizational level can help workers feel more at home and more safe in their workplace,” McCall said. “Some other strategies could include diversifying front office staff, leadership and board members, as well as providing training organization-wide on things like implicit bias, systemic racism.”

PHI estimates the direct care workforce will need to add 7.4 million new jobs in less than a decade to meet the growing demand for care from 72 million baby boomers. It also estimates the industry will need to fill another 6 million positions as existing direct care workers leave the field or retire. 

McCall said to meet that demand, there needs to be cooperation between local and state workforce development agencies, as well as managed care organizations to develop a pipeline of available workers. While the American Recovery Act has funneled more money to state Medicaid programs, McCall said higher Medicaid reimbursement rates need to be sustained in order for home care agencies to pay workers higher wages.

“We hear from employers in the field that they would pay these workers $20 to $25 an hour if they could, but they can’t because of these extremely low rates.