Who Enters and Who Exits Direct Care Jobs in Long-Term Care Settings?
Krista Ruffini, Karen Shen, Yulya Truskinovsky
Brookings Institution, September 2026
Key takeaways
Both residential care and home care settings routinely face challenges attracting and retaining direct care workers, leading to widespread worker shortages and high turnover that threatens the industry’s ability to provide high-quality care.
In order to design effective policies to attract and retain direct care workers, it is essential to understand which industries and occupations these direct care workers come from, and the characteristics of workers and jobs that are associated with direct care worker retention.
Krista Ruffini, Karen Shen, and Yulya Truskinovsky analyze worker flows into and out of the direct care workforce between 2010–25.
The authors leverage nationally representative longitudinal data to describe characteristics of workers who leave and those who stay in these roles, and characterize earnings trajectories for those who stay and those who move to different jobs.
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