The Healthcare Workforce during COVID-19: Results from an Environmental Scan

Publication Date: August 4, 2021
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  • Pages: 26
  • Published: 2021


Research Questions

  1. How did the COVID-19 pandemic change the labor market for healthcare workers in HPOG-targeted occupations, including changes in labor demand, labor supply, and wages?

Prior to the COVID-19 pandemic’s onset in the United States in early 2020, policymakers saw the healthcare system as providing opportunities to employ low-income individuals in jobs with potential for good wages and career advancement. The pandemic may have changed those assumptions.

This brief reviews changes in the labor market for healthcare workers from January through September 2020. The brief focuses on occupations targeted by a significant ongoing investment in healthcare workforce development: the Health Profession Opportunity Grants (HPOG) awarded by the Administration for Children and Families (ACF) within the U.S. Department of Health and Human Services.


The HPOG Program and the associated evaluation will make an important contribution to the field’s collective knowledge about sector-based and career pathways programs. The brief intends to inform HPOG grantees, policymakers, and the healthcare workforce field about the state of the labor market for occupations and industry sectors targeted by HPOG programs. The brief’s findings may be of interest to these stakeholders as they interpret the results from forthcoming impact evaluation analyses or develop future investments in healthcare workforce programs.

Key Findings and Highlights

Analyses in this brief find:

  • More than half of all HPOG participants enroll in training for either Certified Nursing Assistant, Home Health and Personal Care Aide, Licensed Practical Nurse/Licensed Vocational Nurse, or Registered Nurse occupations. People in these occupations tend to be employed in the hospital, nursing and residential care, or home healthcare sectors.
  • During the pandemic, healthcare sector employment fell over 9 percent from January to April 2020 but recovered about 60 percent of those losses through September 2020. Employment patterns in those sectors that tend to employ the four healthcare occupations that are most-often targeted by HPOG differed from the overall industry and from each other.
  • Evidence suggests changes in demand for healthcare services and, in turn, workers largely explain the observed employment decrease and partial recovery. However, nursing and residential care facilities also faced severe challenges related to rising cost of care, which affected employment.
  • There was substantial slack in the healthcare labor market (i.e., excess labor supply due to the recession), relative to the pre-pandemic environment. Individual workers reported complex challenges associated with their ability and willingness to work at that time.


The brief summarizes the results of an environmental scan of published research, analysis, and reporting and analysis of publicly available labor market data through September 2020. Our approach to identifying relevant sources was twofold. First, we interviewed subject matter experts. We then conducted an unstructured search for sources, using search topics recommended during the expert interviews. We include sources from national press outlets, professional association reports/newsletters, gray literature, and academic literature.


Considering the findings, the authors recommend the following future research topics:

  • Gathering data on the characteristics of employers — particularly industry sector and firm size — that hire HPOG trainees would inform our understanding of trainees’ risk for pandemic-specific effects and other aspects of their experiences in the labor market.
  • Researchers and industry experts should consider lessons to be learned from the current pandemic, both to inform the ongoing response and to prepare the healthcare workforce for future disruptions.
  • If demand for healthcare services shifts toward in-home care in the long run, future research could explore potential for expansion of both HHA and PCA trainings among HPOG grantees in addition to strategies for increasing compensation for these traditionally low-wage occupations.
  • Findings suggests a likely decline in the level of employment and earnings among those who graduate HPOG during the recession. Whether the pandemic altered the impact of HPOG on graduates will depend on the extent to which HPOG prepares workers relatively better than do alternative providers in this pandemic environment, which we will consider via the ongoing evaluation of HPOG 2.0 grantees.


Epstein, Zachary and Maureen Sarna. 2021. The Healthcare Workforce during COVID-19: Results from an Environmental Scan, OPRE Report 2021-104. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.


Administration for Children and Families
Temporary Assistance for Needy Families
Health Profession Opportunity Grants
Certified Nursing Assistant
Home Health Aide and Personal Care Aide
Licensed Practical Nurse/Licensed Vocational Nurse
Registered Nurse