Compensation Stability and Workforce Retention During COVID-19: A Paired Comparative Study of Home Care Nurses

Background/Objectives: Home care nurses play a vital role in maintaining continuity of care for vulnerable populations. However, the COVID-19 pandemic exposed long-standing vulnerabilities in the workforce within home and community-based services. While compensation is often emphasized as a primary driver of workforce retention, less is known about how compensation satisfaction and retention intentions changed over time during a public health emergency. Methods: This study employed a cross-sectional survey with retrospective paired comparisons among home care nurses at five home care agencies in Maryland. To assess temporal changes, respondents retrospectively evaluated compensation satisfaction, job satisfaction, and retention intentions before and during the COVID-19 pandemic. Paired samples t-tests were used to examine within-respondent differences across time periods. Herzberg's Motivator-Hygiene Theory guided the interpretation of these changes in extrinsic and intrinsic workplace factors. Results: Compensation satisfaction did not differ significantly between the pre-pandemic and pandemic periods. In contrast, selected retention-related perceptions, particularly financial stability and feeling well paid, changed significantly and were associated with organizational and preparedness-related factors such as leadership, communication, and professional growth opportunities. Several intrinsic job satisfaction dimensions improved during the pandemic, while resource-related challenges remained. Conclusions: The findings suggest that compensation stability functioned as a hygiene factor that was insufficient to secure workforce retention during the COVID-19 pandemic. Retention intentions were shaped by the interaction of financial security and organizational preparedness. Workforce policies to strengthen home care systems should combine compensation strategies with leadership development, professional growth opportunities, and emergency preparedness planning to build resilience during future crises.