Evidence map›Paper›PMID 40523645›Full record

ArticleJournal of the American Medical Directors Association2025

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

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

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Katherine E M MillerDepartment 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. Electronic address: Kmill177@jh.edu.
Yang YangDepartment 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.
Jeromie BallreichDepartment 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.
Karen ShenDepartment 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.

Funding

Advancing Workforce Analysis and Research for Dementia (AWARD) NetworkR24AG077014 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOANNE E. SPETZ · 2022 to 2026
$1.9M
NIA NIH HHS R24 AG077014
6 · The paper itself

Abstract

objectivesDue 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.

designWe 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

participantsThe 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).

methodsWe 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.

resultsDirect 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.

Indexed as

Direct care workershealth policyhome careMedicaid

Identifiers

PMID40523645
PMCPMC12408099

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.