About The Study: In this cross-sectional study of direct care workers (DCWs), employer ownership status and unionization were independently and jointly associated with DCW workforce turnover rates, suggesting that these structural factors may play an important role in DCW retention. State and federal policies that facilitate DCW unionization or public employment of DCWs may significantly improve DCW retention. Direct care workers—a broad workforce that includes home health aides, certified nursing assistants, and personal care aides—provide essential support for older adults and individuals with disabilities in the home, nursing homes, and hospital settings.
Corresponding Author: To contact the corresponding author, Geoffrey M. Gusoff, MD, MBA, MS, email ggusoff@mednet.ucla.edu .
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(doi:10.1001/jamanetworkopen.2026.4636)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.
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