Long-Term Care Workers Saw Continuously High Turnover Rates in 2021

While most healthcare turnover rates appear to be back on track to return to pre-pandemic levels, certain personnel, including long-term care workers and health aides and assistants, saw high turnover rates and slow recovery in 2021, according to a study published in JAMA Health Forum.

Although healthcare workers were essential in treating and caring for COVID-19 patients, around 1.5 million lost their jobs in April 2020. Healthcare workers also chose to leave their jobs due to the risk of contracting COVID-19, poor availability of personal protective equipment, burnout, and inadequate compensation.

Since then, all healthcare sectors have experienced fluctuating staffing rates, with many still facing workforce shortages.

Although healthcare employment grew in some areas throughout the pandemic, a number of settings have not been as lucky.

To understand the specific impact COVID-19 had on the healthcare workforce, researchers compared pre-pandemic healthcare worker turnover rates to pandemic turnover rates using data from the Current Population Survey (CPS) for more than 125,000 healthcare workers.

The study focused on eight healthcare occupations: physicians, advanced practitioners, registered nurses, therapists, healthcare technicians, licensed practical nurses (LPN) and licensed vocational nurses (LVN), community-based workers, and assistants and aides. Researchers also noted turnover rates in four specific settings, including hospitals, ambulatory care, long-term care, and other healthcare settings.

The study included turnover rates from January 2019 to March 2020, defined as the pre-period, April to December 2020, defined as post-period one, and January to October 2021, defined as post-period two.

The pre-pandemic period yielded an average 3.2 percent healthcare worker turnover rate. This figure increased to 5.6 percent during post-period one and decreased to 3.7 percent in post-period two. 

While the decline in 2021 neared pre-pandemic levels, researchers noted that turnover rates during the pandemic varied by healthcare setting and occupation.

For example, turnover rates among long-term care workers continued to increase in post-period two. In contrast, the turnover rates in hospitals, ambulatory care, and other settings peaked during 2020 and decreased to slightly higher than pre-pandemic rates in 2021.

Health aides and assistants had the highest turnover rates throughout the study period, with the post-period two rate remaining 1.3 percentage points higher than the pre-period rate. Healthcare technicians and LPNs and LVNs had high turnover rates in 2020, but technicians saw a more significant decline in 2021 compared to LPNs and LVNs, the study found.

Researchers suggested that these trends were likely associated with the increased turnover rates in the long-term care setting, which commonly employs health aides and assistants and LPNs and LVNs.

Physicians had the lowest overall turnover rates throughout the study period, perhaps due to the high wages associated with the job. However, it was the only occupation that continued to see turnover increases in 2021.

Other factors, such as having children and race, impacted healthcare workforce turnover as well.

Women and men with children under five years old were more likely to experience turnover and experienced slower recovery in 2021 than workers without young children. Additionally, women with and without children had higher turnover rates than their male counterparts.

White healthcare workers had the lowest turnover rates during the pre-period and post-period one. In post-period two, workers who reported being of multiple or other races or ethnicities experienced the lowest turnover rates. These workers were also the only group that saw lower turnover rates in 2021 compared to before the pandemic.

Meanwhile, Asian healthcare workers had the highest turnover rates in post-period one but saw the greatest recovery in post-period two. American Indian/Alaska Native/Pacific Islander healthcare workers also saw high turnover rates in 2020 and returned to almost pre-pandemic levels in 2021.

Black and Latino healthcare workers saw turnover decreases in 2021, but the recoveries were notably slower than other races.

“The COVID-19 pandemic has put on full display the inequities of job security and of benefits available to workers of racial and ethnic minority groups, combined with the unbalanced community exposure to and treatment of COVID-19—all of which are factors that put employment at risk,” the study stated.

As the pandemic continues, it is critical to track healthcare worker turnover for industry leaders to determine areas for improvement, whether it be job placement, retention, or quality, researchers concluded.