The Long-Term Care Nursing Pipeline: Factors Associated With Upward Career Mobility Among Residential Long-Term Care...

Given the long-term care (LTC) staffing "crisis," it is important to understand factors associated with upward career mobility in residential LTC settings. The study aimed to understand the individual and organizational factors associated with upward career mobility among direct care workers (DCWs) in residential LTC settings.

Cross-sectional analysis using data from the 2024 National Dementia Workforce Study, a nationally representative survey of LTC facilities and staff in the United States.

US nursing homes and assisted living communities, where registered nurses (RNs), licensed practical nurses (LPNs), and unlicensed DCWs (ie, certified nursing assistants, home health, personal care, and medication aides) were employed.

We used a generalized linear mixed model with facility random effects to examine individual (eg, sex, age, foreign born) and organizational (eg, ownership, benefit, staffing) characteristics associated with upward career mobility among unlicensed DCWs.

In assisted living communities (n = 396 staff), 9% of staff were LPNs/RNs, of whom 23% had previously worked as unlicensed DCWs. Among current unlicensed DCWs, 33% reported enrollment in a certification, licensure, or health care degree program. In nursing homes (n = 370 staff), 34% were LPNs/RNs, of whom 47% had formerly worked as DCWs. Among current DCWs, one-third reported seeking professional advancement. After adjusting for covariates and facility random effects, DCWs' professional advancement was significantly associated with younger age (adjusted odds ratio [AOR], 0.93; P < .001), being foreign born (AOR, 3.23; P < .001), and working in not-for-profit (AOR, 0.49; P = .013), larger (AOR, 1.01; P = .009), chain-affiliated facilities (AOR, 2.55; P = .007), with a lack of paid time off (AOR, 0.49; P = .007), and higher direct care staffing levels (AOR, 1.25; P = .041).

One-third of current LTC DCWs are actively pursuing healthcare credentials, indicating strong potential for workforce advancement from within LTC settings. Additional research is needed to identify the practice and policy interventions that facilitate upward career mobility and address workforce shortages in LTC.