Unionization, Ownership Status, and Direct Care Worker Turnover

Area of Science:

• Healthcare workforce research
• Socioeconomic factors in healthcare

Background:

• Direct care workers (DCWs) are crucial for older adults' care in the US.
• High turnover rates among DCWs negatively impact care access and quality.
• The influence of structural factors like unionization and employer ownership on DCW retention is not well understood.

Purpose of the Study:

• To investigate the association between unionization, employer ownership status, and workforce turnover among direct care workers.

Main Methods:

• A cross-sectional study utilizing data from the Current Population Survey (2009-2024).
• Included 18,175 individuals employed as DCWs.
• Analyzed the impact of union coverage and employer type (for-profit, nonprofit, public) on 1-year turnover rates using logistic regression.

Main Results:

• Unionized DCWs had significantly lower turnover rates compared to non-unionized DCWs (37.4% vs. 45.0%).
• This effect was significant in nonprofit and for-profit settings, but not in public employment.
• Publicly owned employers were also associated with lower turnover compared to for-profit employers.

Conclusions:

• Unionization and employer ownership (nonprofit, public) are independently and jointly associated with lower direct care worker turnover.
• These structural factors are important for DCW retention.
• Policies promoting DCW unionization and public employment could enhance workforce stability.