Why Do Direct Care Workers Leave Their Jobs, and Where Do They Seek Work Next?
Low wages, insufficient hours, limited benefits, high workplace injury rates, and many other precarious working conditions lead to high rates of turnover and churn in the U.S. direct care workforce. However, little is known about the characteristics of the workers who leave direct care occupations, and little is known about the next steps they take.
To investigate these questions, PHI recently completed a study of annual occupational mobility among direct care workers.
Our research finds that 81 percent of direct care workers remain in this workforce in a given year. Among those who leave their current direct care occupations, the most common transition is into another direct care occupation. For example, one-third of home health aides who transition to another occupation in a given year become personal care aides, and nearly a quarter take on work as nursing assistants. These findings likely reflect both a deep commitment to this work and limited alternative employment opportunities. They also confirm the importance of robust training opportunities and portable credentials for direct care workers who seek to move across occupations and settings.
Among those workers who leave direct care each year, we find that seven percent move into jobs in other sectors, three percent become unemployed, and eight percent leave the labor force entirely.
What occupations do workers enter when they leave the direct care workforce? Our research finds that a majority of these workers transition into other occupations within health care, most commonly becoming medical assistants, followed by dental assistants and medical equipment preparers. Notably, 95 percent of these transitions are into occupations that offer higher median wages without requiring higher levels of education or training—indicating that low wages are likely a key determinant of direct care workers’ exits. Indeed, previous PHI research has shown that the median hourly wage for direct care workers is less than the median wage for workers in other occupations with similar or lower entry-level requirements in every state across the country.
Our research finds that direct care workers who are white, men, or who are under the age of 40 are more likely to leave their jobs for an occupation outside of direct care, while women of color and people 40 and older are most likely to remain in the direct care workforce. This underscores the imperative to better recognize the contributions of all direct care workers and reward tenure over time.
Overall, these findings highlight the need to raise direct care wages to a competitive level, improve benefits to better support and retain direct care workers, and build out career ladders and lattices in this sector. By improving compensation, training, and advancement opportunities, policymakers and employers alike can reward direct care workers’ commitment and reduce workforce churn while also recruiting new workers into the field.
