The Direct Care Workforce in Rural Areas

Research center:
Lead researcher:
Project funded:
September 2021
Anticipated completion date:
May 2023

There is substantial evidence that a low supply of direct care workers is already occurring in long-term care services and supports (LTSS), although limited research has distinguished between rural and urban areas. Employer and industry turnover among direct care workers are chronic problems in LTSS, but there has been insufficient attention to rural/urban differences. A number of studies have indicated that compensation is a strong predictor of job exits among direct care workers, and higher wages are related to lower turnover. In 2017, median annual earnings for full-time, year-round women home care workers were $23,500. For women working in institutional settings, median annual earnings were $25,600. Only 24% of home care workers and 41% of direct care workers in institutional settings have employer-based health insurance. A lack of resources and financial vulnerability may make it difficult for workers to stay employed. For example, a lack of access to reliable transportation or childcare may make it difficult for workers to maintain steady employment. Direct care workers may also change employers or exit the LTSS industry for other industries that pay higher wages; while little research has examined differences in turnover among direct care workers in urban and rural areas, rural areas may have fewer job alternatives, leading to lower employer and industry turnover.

The research in the proposed study will provide important insights about a key policy issue for the care of older adults in rural areas: how to retain LTSS workers in a climate of growing need. Further, the research will be conducted and disseminated utilizing an equity lens, emphasizing that improving the compensation of direct care workers needs to be a priority not only for the well-being and quality of care for older adults in rural areas, but also for the well-being of the direct care workers providing these essential services and their families.


  • Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2022
    The policy brief examines disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas. Researchers estimate the ratio of home health aides and nursing assistants relative to the population of adults (age 65+) across rural and urban areas in the U.S.