The onset of the COVID-19 pandemic presented the healthcare industry with an enormous challenge.
Surging cases overwhelmed hospital systems. Healthcare workers feared for their own health and that of their families. Nationwide lockdowns brought large portions of the economy, including healthcare, to a halt.
Policymakers often rely on the healthcare sector to provide opportunies to employ low-income individuals in jobs with potential for good wages and career advancement. To work in healthcare, including entry-level jobs, workers typically have to complete some form of training and acquire specific credentials. Programs such as the Health Professions Opportunity Grants (HPOG) support workers with occupational training and services to help them prepare for and attain in-demand healthcare jobs.
But the pandemic threw the industry into turmoil, raising the question of how COVID-19 affected the labor market for those jobs. To explore this question, we turned to the nascent research literature, industry reporting, and publicly available labor market indicators during the first waves of COVID-19 cases (i.e., through September 2020).
Roughly 2,500 people were in training just before the onset of the pandemic. Most train for jobs at different levels of the nursing career pathway: certified nursing assistants, home health and personal care aides, licensed practical/vocational nurses, and registered nurses. We focused on the sectors that typically employ these workers, namely nursing and residential care facilities (i.e., long-term care), hospitals, and home healthcare.
- The long-term care sector shed thousands of jobs in Spring 2020. While employment across other healthcare sectors either stabilized or partially recovered over the summer, long-term care facilities continued to reduce employment. Driven by increases in operating costs, some employers consolidated staffing or closed altogether. Those facilities that reported shortages of nurse’s aides and nurses were more likely to have experienced an outbreak of COVID-19 that could have driven workers away.
- Though hospitals function as the epicenter of the pandemic reponse, employment also dropped across hospital systems nationwide in the first months of the pandemic, likely due to decreased demand as a result of lockdowns and cancellations of voluntary medical procedures. Hospital addmissions dropped 70 percent below industry expectations. To the extent that hospital systems report labor shortages, those shortages were concentrated among critical care positions (e.g., hospitalists and critical care nurses), most of which require substantially more education than HPOG-supported training would be expected to provide, with one exception: respiratory therapists. However, less than one percent of HPOG participants enrolled in respiratory therapist training prior to the pandemic.
- Home healthcare followed a pattern comparable to the rest of the healthcare industry, as sharp decreases in demand for services drove down employment in Spring 2020, followed by partial recovery through the summer. Industry analysts estimated a 16 percent decrease in the volume of home healthcare visits, but some expect the industry to benefit in part from a shift away from facilities toward more healthcare at home.
In general, despite some plausible expectation to the contrary, the initial onset of the COVID-19 pandemic (i.e., Spring to Fall 2020) decreased demand for low-skill healthcare workers writ large. So, what does this mean for HPOG program operations and expected impacts on participants’ labor market outcomes?
My colleagues at Abt are actively pursuing both questions. An upcoming paper will review HPOG grantees’ response to the pandemic. Whether the pandemic altered HPOG program impacts on participants will depend on the extent to which the programs prepared workers for the pandemic economy better than other healthcare training providers or alternative employment opportunities. That the initial evidence suggests a decline in the level of healthcare employment does not necessarily imply a decline in the impact of the programs. The impact evaluation team at Abt Global will explore these dynamics in future reports.
The pandemic is ongoing and requires continued monitoring of its impact on HPOG programs and participants. Since this scan was completed, a third wave of cases and hospitalizations affected states and regions that had not yet experienced a large-scale outbreak. The lifting of lockdowns and distribution of vaccines altered the pandemic labor market further, and an ongoing fourth wave, driven by the Delta variant, poses a challenge to the healthcare industry once again. Hospital systems continue to grapple with the recovery from lost revenue, and healthcare workers are re-considering their willingness to continue their careers in the industry. Departures could open up more opportunities for HPOG participants, but participants ultimately may be reluctant to enter the healthcare sector. The long-term implications of COVID-19 on entry-level healthcare training are unclear and require further research and evaluation.
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