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November 9, 2020

The Challenge in Tracking Unemployment Among Health Care Workers and Why It Matters

Author Affiliations
  • 1Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle
JAMA Health Forum. 2020;1(11):e201358. doi:10.1001/jamahealthforum.2020.1358

The health care industry lost 1.5 million jobs between March and April 2020, the height of the coronavirus disease 2019 (COVID-19) pandemic in the US. More than half a million jobs remain lost 6 months later, with losses spread across the major health care sectors of hospitals (22.7%), ambulatory care settings (39.6%), and long-term care (LTC) facilities (37.7%). The job loss in LTC facilities (eg, skilled nursing facilities, residential care, assisted living) represents 6.2% of their workforce compared with 2.8% in ambulatory care and 2.4% in hospitals. The LTC sector has seen a steady decline in employment since the start of the pandemic, while the other health care sectors have mostly rebounded. The job loss in LTC is concerning but not surprising, given reports of high COVID-19 risk and burnout. Tracking these unemployed workers is a challenge yet is necessary to develop a strategy to strengthen the LTC workforce and improve health care delivery.

National Tracking of Unemployment Claims at the Occupation Level

Most analyses of health care job loss have been reported by sector rather than by occupation. Also, job loss has been calculated by tracking the number of employed across time. Identifying those who are unemployed—those actively seeking employment and able to work—is challenging. State employment offices have been overwhelmed with processing high claim volumes and managing fraudulent claims, making reporting of detailed occupation data a low priority. When unemployment claims data are reported, it is difficult to disentangle the various unemployment insurance programs, including regular state initial and continued claims, Pandemic Emergency Unemployment Compensation (extending regular benefits for 13 weeks), and Pandemic Unemployment Assistance (for self-employed or part-time workers not otherwise qualified for regular assistance). State data are fed into the Employment and Training Administration of the US Department of Labor, which then publicly reports occupation-specific data among continued claims and without detail on industry. In health care, occupations are reported in 1 of 2 broad categories: (1) health care practitioner and technical occupations (eg, physicians, registered nurses, therapists) and (2) health care support occupations (eg, home health aides, certified nursing assistants). While these data have been useful to see that support workers are experiencing slower recovery than health care practitioner and technical workers, we do not know which specific occupations are lagging.

State partnerships can be leveraged to obtain and analyze detailed occupation data. In Washington state, our academic research center partnered with the Washington Workforce Training and Education Coordinating Board, the Washington Employment Security Department, and the Washington State Health Care Authority to obtain and analyze weekly claims data. In our analysis, we saw unemployment rising among nursing aides/home health aides.

Understanding the Financial Vulnerability of Unemployed Health Care Workers

A recent analysis of unemployed workers found that minority, immigrant, and less-educated individuals are disproportionately affected by job loss and are experiencing not only income loss but also food insufficiency and delays in medical care. Emerging reports are documenting the considerable financial setbacks experienced by working women during this crisis. We know that the majority of LTC workers are women of color with less than a bachelor-level education who are paid low wages and have limited access to health insurance, child care, and sick leave benefits.

Public data sets are key to understanding financial vulnerability and its consequences, especially the Current Population Survey (CPS) conducted by the US Bureau of Labor Statistics, which tracks monthly employment changes, along with sociodemographic characteristics, for a complex panel of individuals. Unfortunately, the pandemic has resulted in a dramatic drop in response rates to the CPS, which a RAND Corporation report found may result in underestimates of unemployed workers, particularly Black workers. Additionally, employees who were not at work during the reference week due to temporary closures or other pandemic-related reasons have been misclassified, an issue now being resolved. Future reporting of unemployed health care workers using public data sets such as CPS needs to account for these limitations. As federal budgets tighten in future years to manage the economic effects of the COVID-19 pandemic, we need a public commitment to support data collection efforts that enable the US Bureau of Labor Statistics and other agencies to ensure accurate representation from all communities.

Identifying Ways to Help Unemployed Health Care Workers While Protecting Patients

Health care workers are facing difficult choices about their future employment, which in part has been fueled by the ending of the Pandemic Emergency Unemployment Compensation program in July, state unemployment benefits drying up for many by the end of 2020, and uncertainty about a second stimulus bill. Tracking reasons for unemployment during this pandemic is difficult; therefore, CPS introduced new workforce questions in May to improve context around job loss, such as the extent to which respondents’ employers had to close business. We know, however, that many nursing home workers feel unsafe in their work environments because of the lack of available personal protective equipment and testing and the high risk of infection. A qualitative study1 characterized the difficult choices that home care workers face during the COVID-19 pandemic—dropping out of the workforce to care for their families or returning to work to ensure income while risking infection.

Making LTC jobs high quality needs to be a priority to prevent further job loss and harm to patients. Adequate nursing home staffing, similar to home care staffing needs, is critical to prevent COVID-19 cases and deaths, so the dwindling workforce does not bode well for resident care through the crisis.2,3 Nursing homes need to be prioritized in the distribution of personal protective equipment and testing, but structural changes to LTC reimbursement is also needed to make these jobs able to provide a living wage with better benefits. Partnerships between health care industry leaders and state workforce development boards should be leveraged to build career pathways to ensure that LTC facilities can compete with other industries for a qualified workforce as the economy strengthens.

Tracking how the health care workforce fares during the pandemic and recovery is not just a numbers exercise. Understanding which health care workers, especially in LTC, are experiencing persistent unemployment, and why, is critical to target policy actions. Without a strong health care workforce, we risk delaying recovery from this pandemic.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Corresponding Author: Bianca K. Frogner, PhD, Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, 4311 11th Ave NE, Suite 210 (Box 354982), Seattle, WA 98195 (bfrogner@uw.edu).

Conflict of Interest Disclosures: None reported.

Sterling  MR, Tseng  E, Poon  A,  et al.  Experiences of home health care workers in New York City during the coronavirus disease 2019 pandemic: a qualitative analysis.   JAMA Intern Med. 2020;180(11):1453-1459. doi:10.1001/jamainternmed.2020.3930PubMedGoogle ScholarCrossref
Gorges  RJ, Konetzka  RT.  Staffing levels and COVID-19 cases and outbreaks in US nursing homes.   J Am Geriatr Soc. Published online August 8, 2020. doi:10.1111/jgs.16787PubMedGoogle Scholar
Allison  TA, Oh  A, Harrison  KL.  Extreme vulnerability of home care workers during the COVID-19 pandemic—a call to action.   JAMA Intern Med. 2020;180(11):1459-1460. doi:10.1001/jamainternmed.2020.3937PubMedGoogle ScholarCrossref
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