SPI *Working Paper Financial Security

Financial Well-being of Frontline Healthcare Workers: The Importance of Employer Benefits


Frontline healthcare workers – especially direct care workers (DCWs), such as home health aides, struggle due to low pay, lack of benefits, and difficult working conditions. The need for these workers is growing. Unless frontline healthcare jobs improve, positions may be difficult to fill, and care for vulnerable members of society may be compromised.

In this study, we surveyed 2,321 frontline healthcare workers and conducted in-depth interviews with 30 of these workers concerning pay, benefits, work conditions, and financial well-being. Key survey findings included:

  • Only 39% of workers were eligible for at least four out of five major benefits (e.g., health, retirement).
  • Compared to all U.S. workers, workers had less access to health, retirement, paid leave, dental, and tuition benefits.
  • On average, the proportion of workers who said various benefits were important to them was 41 percentage points higher than the proportion of workers who had access to these benefits.
  • Probabilities that workers had access to most major benefits were:
    • 138% higher among workers with college degrees compared to workers without degrees
    • 206% higher among workers in facility-based settings such as hospitals compared to workers in home health or private duty settings and
    • 24% lower among Black compared to white workers.
  • Black workers, workers without college degrees, and workers in home health or private duty settings had significantly higher rates of 9 out of 10 financial difficulties such as problems paying bills.
  • The greater the number of major benefits to which workers had access, the lower their probabilities for experiencing all 10 financial difficulties – after controlling for income and other factors.
    • For example, the probability of experiencing food insufficiency drops by 28% from having three benefits compared to one.
  • 59% of workers changed jobs at least once in the past year.
  • 34% of workers are somewhat or very likely to leave their current job in the next year.
  • Workers with a greater number of major benefits to which they had access and those with higher levels of job satisfaction were less likely to consider leaving.

In-depth interviewers revealed that workers struggle with challenging work conditions, such as severe staffing shortages. Work is physically and emotionally demanding, and burnout is high. Despite this, they want to remain in healthcare. Pay is the primary factor when considering a job change, yet workers yearned for more tuition assistance to support career development, more help with childcare, and less expensive health insurance. Many workers rely on public benefits and find it stressful to navigate benefits cliffs – the possibility of losing public benefits when income rises above income limits.

Based on these key findings, we outline a set of recommendations for employers, policymakers, and other stakeholders to improve pay, benefits, and work conditions for frontline health workers, especially DCWs, such as:

  • Offering a core package of major benefits: health insurance, paid leave, retirement, dental, and childcare assistance and ensuring workers can afford health insurance premiums.
  • Increasing spending on home and community-based services (HCBS) via Medicaid to raise pay for frontline healthcare workers.
  • Increasing federal funding for childcare subsidies and fixing benefits cliffs


Despard, M., Fox-Dichter, S., Zheng, H., Anderson, G., Borland, O., & Gilbert, K. (2022). Financial Well-being of Frontline Healthcare Workers: The Importance of Employer Benefits. Social Policy Institute Research. https://doi.org/10.7936/64m8-v455