Benefits and Financial Security Among Frontline Healthcare Workers

Background: Nearly a fifth of healthcare workers have quit their jobs during the COVID-19 pandemic (Galvin, 2021) amidst widespread health risks (Belingheri et al., 2020), burnout (Levine, 2021) and mental health problems (Marvaldi et al., 2021). While stressed out doctors and nurses dominate media stories, less attention has been given to direct care workers (DCWs) such as home health aides who are disproportionately women of color and immigrants. Before the pandemic, DCWs struggled with low wages and poor working conditions (Scales, 2022) leading to a shortage of DCWs that is expected to get worse as the over 65 population rises and under 65 population falls (Meyer, 2020). The Build Back Better proposal intends to address these challenges via increased Medicaid funding for Home and Community-based Services (HCBS) including wage pass-throughs. Prior research indicates that access to employer benefits is associated with turnover among DCWs (Luo et al., 2012; Rosen et al., 2011). To further explore this association, we examined variation in access to and use of benefits among frontline healthcare workers in relation to household financial security.

Data and Method: Data come from an online survey administered via Qualtrics among a convenience sample of frontline healthcare workers (N = 2,321), including DCWs. Participants were recruited among organizations affiliated with a national advocacy group for DCWs and via outreach to healthcare employers. Probit regression models with covariance control (e.g., age, household size) were run to estimate marginal effects and predicted probabilities of access to benefits such as health insurance and paid leave and financial security outcomes including various forms of material hardship, food insecurity, and having emergency savings.

Findings: Most (70%) workers had access to health insurance, followed by paid leave (60%), retirement benefits (53%), childcare (41%), and dental benefits (30%). Benefits access was higher among workers with a college degree compared to those without a degree, and among workers in facility-based settings versus home health or private duty. Access to benefits was associated with lower turnover intent, food insecurity, housing, bills, medical care, prescription medication, and credit card payment hardship, as well as income sufficiency and having emergency savings (all p < .001). Having less than a college degree and working in home health or private duty were also statistically significant predictors of several types of financial hardship.

Significance: Our findings suggest that offering strong benefits packages may help employers stem turnover among frontline healthcare workers while promoting workers’ financial security. We also find evidence of occupational segregation as workers in home health and private duty settings and those without a college degree have worse access to benefits. Increased HCBS funding through Build Back Better may help home health agencies offer better benefits, though inequities among workers in private duty settings may remain.