There is substantial evidence that a low supply of direct care workers is already occurring in long-term care services and supports (LTSS), although limited research has distinguished between rural and urban areas. Employer and industry turnover among direct care workers are chronic problems in LTSS, but there has been insufficient attention to rural/urban differences. A number of studies have indicated that compensation is a strong predictor of job exits among direct care workers, and higher wages are related to lower turnover. In 2017, median annual earnings for full-time, year-round women home care workers were $23,500. For women working in institutional settings, median annual earnings were $25,600. Only 24% of home care workers and 41% of direct care workers in institutional settings have employer-based health insurance. A lack of resources and financial vulnerability may make it difficult for workers to stay employed. For example, a lack of access to reliable transportation or childcare may make it difficult for workers to maintain steady employment. Direct care workers may also change employers or exit the LTSS industry for other industries that pay higher wages; while little research has examined differences in turnover among direct care workers in urban and rural areas, rural areas may have fewer job alternatives, leading to lower employer and industry turnover.

The research in this study provided important insights about a key policy issue for the care of older adults in rural areas: how to retain LTSS workers in a climate of growing need. Further, the research was conducted and disseminated utilizing an equity lens, emphasizing that improving the compensation of direct care workers needs to be a priority not only for the well-being and quality of care for older adults in rural areas, but also for the well-being of the direct care workers providing these essential services and their families.

Publications

• Distribution of Direct Care Workforce COVID-19 Funding Between Rural and Urban Counties in Minnesota and Illinois
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 05/2023
  The purpose of this policy brief is to examine trends in the distribution of federal Coronavirus Aid, Relief, and Economic Securities Act of 2020 (CARES Act) funding designed to support the direct care workforce between rural and urban counties in Minnesota and Illinois.
• Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (journal article)
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 02/2023
  In this manuscript, the research team used data from the 2021 Occupational Employment and Wage Statistics dataset to calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US.
• Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (policy brief)
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 11/2022
  The policy brief examines disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas. Researchers estimate the ratio of home health aides and nursing assistants relative to the population of adults (age 65+) across rural and urban areas in the U.S.