Characteristics of Multiple Job Holders in Long-term Care


Tim Bates, Joanne Spetz, and Laura Wagner

February 1, 2022


Health care workers in long-term care (LTC) settings face concerns related to financial security resulting from low wages, inconsistent hours, and a lack of benefits. These factors contribute to higher rates of LTC workers holding multiple jobs. The COVID-19 pandemic has added a new set of concerns stemming from these higher rates of multiple job holding. COVID-19 is an especially serious threat to the frail elderly, nosocomial infections are a driver of outbreaks in LTC settings, and the potential for LTC staff to be a primary route of virus transmission is high. We examined rates of multiple job holding and characteristics of multiple job holders in the LTC workforce.


The information presented is derived from 10 years of pooled basic monthly data files from Current Population Survey. Health care workers providing direct patient care were defined to include registered nurses (RNs), licensed practical and vocational nurses (LPNs), nursing, psychiatric, and home health aides (NPHH), and personal care aides (PCAs). LTC employment settings were defined to include home health care, skilled nursing facilities, residential care, individual and family services, and private households.


The rate of multiple job holding among LTC health care workers was highest for PCAs (7.1%) and RNs/LPNs (6.8%). The average rate of multiple job holding across all LTC occupations and employment settings was 6% compared to just 4.4% for all persons employed outside of LTC. Among all three occupation groups, Black or African American workers accounted for a larger percentage of second job holders in comparison to single job holders. Among RN/LPNs, White workers represented a larger percentage of single job holders relative to second job holders, but a comparatively larger percentage of second job holders among PCAs. Nearly one-third of RN/LPNs and nursing, psychiatric, and home health aides holding multiple jobs reported secondary employment in the same occupation and in a LTC setting. Secondary employment in LTC generally (whether in the same or a different occupation) ranged from 45% to 53% across the occupational groups.


Multiple job holding is a difficult phenomenon to measure. It is plausible that patient care workers employed in LTC settings are more likely than average to engage in alternative work arrangements such as informal home health care services providers. The number of patient care providers in LTC settings who hold multiple jobs may be higher than official estimates. Beyond the challenges posed by a viral pandemic, employment in LTC remains at a competitive disadvantage with other health care settings and many other sectors of employment generally.

Among policy reforms recommended to better support the LTC workforce, reforming how LTC is financed is critical, as it is the most likely pathway to higher wages and more generous benefits across the LTC workforce.

See the full report.