A new white paper from The Project on Workforce revisits the spring and summer of 2020 to identify and evaluate the changes, challenges, and innovations induced by the COVID-19 pandemic to the Massachusetts healthcare labor market.
By Stephanie Taube, Rachel Lipson, Chida Balaji, Graciela Watrous, and Mary Guay in collaboration with the Massachusetts Healthcare Collaborative
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Press Release
Read the official press release at mass.gov
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Executive Summary
The first wave of the COVID-19 pandemic created unprecedented uncertainties in the Massachusetts healthcare workforce. In this white paper, we revisit the spring and summer of 2020 to identify and evaluate the changes, challenges, and innovations induced by the COVID-19 pandemic to the Massachusetts healthcare labor market. We aim to address three broad questions: 1) What were the most significant changes to labor supply and demand in nursing, behavioral health, and direct care at the onset of the pandemic? 2) What actions and strategies did government agencies, employers, and educators deploy to respond to rapidly changing conditions on the ground? 3) Which of these changes are likely to be temporary and which may have lasting effects?
Throughout the first wave of the pandemic, job postings fluctuated by role and setting as employer and patient needs shifted in an uncertain environment. Initial unemployment claims in healthcare occupations increased dramatically and peaked in April and May of 2020, as demand decreased for elective procedures, out-patient care, and in-home care. Following the initial volatility in the spring, the healthcare labor market stabilized somewhat in the summer months, but unemployment remained persistent. However, the numbers concealed wide variation across roles, care settings, and regions in Massachusetts.
In the nursing workforce in Massachusetts, trends in Unemployment Insurance (UI) claims and job postings varied by region and specialization in 2020. Many ambulatory care nurses were laid off or furloughed, and the shortage of Critical Care Nurses intensified. The first wave of the pandemic interrupted an already-restricted pipeline of new nurses, limiting clinical placements and increasing wait times for licensing exams. Attrition and retirements among Registered Nurses (RNs) accelerated during the spring and summer of 2020, posing long-term workforce challenges, as increasingly tough working conditions deterred an aging RN workforce.
Direct care workers were also on the front lines of the pandemic. The impact of the first wave on job postings and UI claims varied greatly for different direct care roles. Job postings for Certified Nursing Assistant (CNA) positions remained high, especially in long-term care (LTC) facilities, but were inconsistent for both Home Health Aides (HHAs) and Personal Care Aides (PCAs). The already-limited pipeline of new direct care workers was interrupted during the first wave, as clinical training and licensing exams grew increasingly unavailable.
For behavioral health workers, job postings decreased in April 2020, while new UI claims increased dramatically in April and May. However, both job postings and UI claims approached pre-pandemic levels by August 2020. Consumer request for behavioral health services appeared to increase during the first wave of the pandemic, as the crisis intensified stress on mental and behavioral health issues. The use of telehealth increased in behavioral health, as virtual services were rapidly implemented to reduce in-person exposure.
As these immense and unprecedented challenges in the healthcare workforce emerged during the first wave of the pandemic, Massachusetts piloted new and innovative approaches to educating healthcare trainees, providing patient care, and filling essential roles. To help address recruitment and hiring challenges in long-term care facilities, the Commonwealth of Massachusetts developed its first-ever online job portal dedicated to these roles. As COVID reduced access to on-site classes and clinical placements for healthcare students, training providers across the state have implemented and expanded programs for healthcare students to engage in remote learning.
State and Federal regulators also responded rapidly to support healthcare workers, employers, and consumers. New policies allowed out-of-state nurses, nurses with expired licenses, and nursing students in their final semester of school to enter the nursing workforce in Massachusetts. Several CNA licensing and clinical placement requirements were also relaxed or waived. In addition, after the onset of the pandemic, both Federal and State regulators approved hazard pay for many essential workers.
While the focus of this white paper is on the initial months following the onset of the pandemic, we also propose questions for future research in student enrollment in healthcare training programs, updates to CNA curriculum and licensing, transitioning displaced workers into healthcare roles, retirement rates among nurses, shifts in care settings, and the utilization of telehealth.
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