Financial Vulnerability and Worker Well-Being: A Comparison of Long-Term Services and Supports Workers With Other Health Workers

Two Women in Meeting with each otherIn a recent article in Medical Care Research and Review, Ulrike Muench, RN, PhD, Matthew Jura, PhD, and Joanne Spetz, PhD, along with their colleagues, share their findings from the first study to look at how the long-term services and supports (LTSS) sector workforce (comprised of registered nurses, licensed practical/vocational nurses (LPN/LVNs), certified nursing assistants, home health aides, and personal care assistants) allocates time between work and leisure activities. 

Employment needs for this workforce sector are estimated to grow by 36% by 2028 and challenges retaining workers due to low wages and high turnover exacerbate the ability to meet this demand.  Stressors outside of the workplace, such as lack of time for leisure and family relationships, potentially play a contributing role to burnout and turnover rates. These workers are predominantly women, with home and personal care aides mainly people of color, immigrants, and educated at the high school level or less.

The researchers used 16 years of data from the American Time Use Survey to examine financial vulnerability and well-being of high-skill and low-skill LTSS workers compared with other health care workers. These data are underutilized in health services research and have much to offer for understanding the lives of Americans, allowing insights into the time constraints individuals face.  

All LTSS workers had significantly lower wages than their colleagues in other health occupations and low-skill LTSS workers were approximately twice as likely to live in poverty as other health workers. While both high-skill and low-skill LTSS workers spent more time at work and traveling to work, high-skill LTSS workers were likely to have other financial and household resources that allow them to obtain help with household and child care responsibilities. 

The researchers found that low-skill LTSS workers were particularly pressured, experiencing lower wages and increased poverty compared with workers in other health care occupations, while also spending more time on paid and unpaid responsibilities such as working, commuting to work, and household and child care activities. Their results reinforce the need for employers and policymakers to develop strategies to support wage mobility, career advancement, and employer-integrated benefits focused on building a healthier workforce.


Ulrike Muench, RN, PhD, FAAN

Ulrike Muench, RN, PhD, FAAN

Dr. Muench’’s research interests include applied health care economics, roles of nurses
and nurse practitioners, gender inequality in the workplace, program evaluation,
and patient outcomes.





Joanne Spetz
Joanne Spetz, PhD

Dr. Spetz’s research interests include the economics of the health care workforce,
shortages and supply of registered nurses, organization and quality of the hospital
industry, impact of health information technology, effect of medical marijuana policy
on youth substance use, and the substance use disorder treatment workforce.