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This study quantifies economic and health costs linked to workforce instability, focusing on avoidable emergency department visits, hospitalizations, and long-term care admissions arising from staffing shortages. Using longitudinal workforce and wage data and Pennsylvania Medicaid data, findings show shortages increase preventable ED visits by 15–20% and hospitalizations by 12–18%, adding up to $75 million in excess Medicaid expenditures annually. The state’s crisis is more severe than the national average by about 10%, particularly affecting rural and low-income populations.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-cost-of-direct-care-workforce-instability-economic-and-health-impacts-of-high-turnover-in-pennsylvania-research-report/426246/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-cost-of-direct-care-workforce-instability-economic-and-health-impacts-of-high-turnover-in-pennsylvania-research-report/426246.png","ImageObject",300,407,{"name":92,"@type":93},"eBook King","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What problem does the study address?","Question",{"text":113,"@type":114},"The study addresses growing instability in Pennsylvania’s direct care workforce, driven by high annual turnover rates and an expected workforce shortfall by 2026.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How do staffing shortages affect health outcomes?",{"text":118,"@type":114},"Shortages are associated with a 15–20% increase in preventable emergency department visits and a 12–18% increase in hospitalizations.",{"name":120,"@type":111,"acceptedAnswer":121},"What are the estimated financial impacts for Medicaid?",{"text":122,"@type":114},"The study estimates that turnover-linked shortages could add as much as $75 million in excess Medicaid expenditures annually.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},426246,1790740007,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":81},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Innovation in Aging, 2025, Vol. 9, No. S2 537  \nAbstract citation ID: igaf122.1837  \nTHE COST OF DIRECT CARE WORKFORCE  \nINSTABILITY: ECONOMIC AND HEALTH IMPACTS OF  \nHIGH TURNOVER IN PENNSYLVANIA  \nSarah Aviña, Amanda Kreider, and Howard Degenholtz, University of Pittsburgh, Pittsburgh, Pennsylvania, United States  \nPennsylvania’s direct care workforce crisis is intensifying, with annual turnover rates between 44–65% and an estimated shortfall of over 37,000 workers by 2026. While workforce shortagesin long-term services and supports (LTSS) are well-documented, the financial burden of turnover remains underexplored. This study quantifies the economic and health costs of workforce instability, focusing on avoidable emergency department (ED) visits, hospitalizations, and long-term care admissions linked to staffing shortages. Using longitudinal workforce and wage data from the Bureau of Labor Statistics (BLS), PHI, and the Pennsylvania Department of Human Services (DHS) 2025-2026 Blue Book, along with Pennsylvania Medicaid data from 2024-2025, we assess turnover trends and cost implications. We find that direct care workforce shortages are associated with a 15-20% increase in preventable ED visits and a 12-18% increase in hospitalizations, adding as much as $75 million in excess Medicaid expenditures annually. Comparing Pennsylvania’s LTSS workforce trends against national data suggests that that the state’s crisis is disproportionately severe, surpassing the national average by 10%, with rural and low-income populations disproportionately affected. Findings indicate that each direct care worker turnover costs providers an estimated $4,200, leading to millions in annual financial losses and service instability. Policy recommendations include retention-based Medicaid reimbursements, expansion of direct care worker roles in interdisciplinary care teams, and pipeline initiatives. This study underscores the need for evidence-based policy reforms to address workforce instability and prevent excess healthcare costs in the Medicaid LTSS system.","cbCaiehPXqQ02jKZ","https://ap.wps.com/l/cbCaiehPXqQ02jKZ","pdf",46836,"English","# Abstract\n## Workforce turnover in Pennsylvania\n## Economic and health cost estimates\n## Comparisons with national trends and affected populations\n## Policy recommendations","[{\"question\":\"What problem does the study address?\",\"answer\":\"The study addresses growing instability in Pennsylvania’s direct care workforce, driven by high annual turnover rates and an expected workforce shortfall by 2026.\"},{\"question\":\"How do staffing shortages affect health outcomes?\",\"answer\":\"Shortages are associated with a 15–20% increase in preventable emergency department visits and a 12–18% increase in hospitalizations.\"},{\"question\":\"What are the estimated financial impacts for Medicaid?\",\"answer\":\"The study estimates that turnover-linked shortages could add as much as $75 million in excess Medicaid expenditures annually.\"}]","The Cost of Direct Care Workforce Instability: Economic and Health Impacts of High Turnover in Pennsylvania - Research Report | PDF",1790639904]