CHIA presents statewide workforce survey: high vacancy and turnover among nurses and direct care workers; 2025 survey refinements planned

Officials from the Center for Health Information and Analysis (CHIA) briefed the Massachusetts Commission on the Status of Persons with Disabilities’ workforce support subcommittee on statewide health care and human services workforce survey results and described plans to refine and relaunch a second survey cycle in 2025.

CHIA staff said their inaugural health care sector survey (fielded May 2023–January 2024) and a follow-up human services sector survey (fielded July–September 2024) show consistently high vacancy and turnover in registered nurse (RN) and direct care roles, widespread reports that pay is not competitive, and that many providers have limited new patient intakes or seen growing waitlists because of staffing shortages.

CHIA’s mission and survey scope

Zizan, deputy executive director for research at the Center for Health Information and Analysis, described CHIA as “a state health data agency” whose mission is to “collect and provide reliable, objective analysis on all health care–related issues and challenges.” CHIA’s workforce survey program covers multiple provider types, including acute care hospitals, nursing homes, home and community‑based providers, behavioral health, community health centers, dental practices, EMS and public hospitals. The agency publishes results in an interactive dashboard with both sector‑level and cross‑sector views.

Key findings

• Sector timing and sample: CHIA said its health care survey was fielded May 2023–January 2024 and its human services survey July–September 2024. For the 2024 human services survey CHIA reported collecting responses from 64 state operators and 197 private operators; CHIA weighted those responses to represent the state’s universe of human services organizations.

• Occupations under pressure: Across surveyed sectors CHIA identified physicians, registered nurses, licensed practical nurses, social workers and direct care workers as the occupations that overlap most across settings. RNs and physicians are concentrated in acute care; licensed practical nurses and direct care workers are concentrated in long‑term care and home‑based settings.

• Vacancy and turnover: CHIA reported the highest RN vacancy rates in home health and nursing homes. The agency also reported high RN turnover in several settings and cited a 47% turnover rate for RNs in adult day health in the slide presented (CHIA slide). For human services, CHIA said vacancy rates were highest for case managers among state operators and for licensed practical nurses among private operators; turnover was high for caseworkers among private operators.

• Recruitment challenges: CHIA respondents most often cited a shortage of eligible applicants and noncompetitive salaries as the principal obstacles to hiring across occupations and sectors.

• Retention challenges: For retaining RNs and direct care workers, CHIA said respondents most commonly flagged burnout, abuse or lack of respect, inflexible scheduling and noncompetitive benefits.

• Strategies employers report using: Increasing wages was the most commonly used strategy for both recruiting and retaining staff across sectors. CHIA also reported widespread use of flexible scheduling, sign‑on bonuses, referral bonuses, expanded training and tuition reimbursement. CHIA noted that some acute care employers reported use of remote work options for certain administrative or nonclinical roles.

• Impact on access: CHIA told the subcommittee that many organizations reported limiting new intakes or new patients and that a majority of organizations reported increases in the volume of patients waiting for services, particularly in behavioral health, community health centers and public hospitals.

Questions and clarifications from the subcommittee

Subcommittee members asked for clarification on CHIA’s definitions of occupational categories, including distinctions among independent licensed clinicians, non‑independent licensed clinicians and levels of direct care workers. CHIA staff said the classifications and examples were developed in consultation with trade groups and state agencies and offered to send the definitions to members for review.

One participant identified in the transcript as “Repcon” said private operators were losing staff to state employers because of higher state salaries. CHIA and other participants discussed existing training and certification routes, including the Medication Administration Program (MAP), which some state vendors use so direct care staff can be certified to administer medication under nursing supervision.

CHIA’s 2025 plans and data refinements

CHIA described a set of planned refinements for the 2025 cycle intended to improve wage and hours reporting and instrument clarity: collecting starting and average hourly wages for a narrow set of occupations (direct care workers and registered nurses), collecting overtime as a percentage of total hours for the same occupations, switching from reporting full‑time equivalent (FTE) counts to total hours for certain components, and adding clearer definitions and a checkbox for respondents who do not collect race/ethnicity data. CHIA said it is fielding the 2025 survey in cohorts, had launched the first cohort the week of the presentation, targeted field completion by June, planned analysis between July and January, and aims to release results “by next January,” per CHIA’s remarks.

Follow‑up actions and next steps discussed

CHIA agreed to share the occupation and leadership definitions used in the instrument and said it would consider external benchmarking sources such as HRD and public transparency tools mentioned by subcommittee members when wage data are not available from respondents. The subcommittee chair said the workforce findings will inform a planned panel of employees with disabilities and their supports, tentatively scheduled for April or May; organizers said they will follow up by email to finalize participants.

What CHIA is not claiming

CHIA staff emphasized that the survey responses were reported by HR directors and administrators on behalf of organizations and do not represent direct exit interviews with individual employees; staff cautioned that some measures (for example, compensation questions in the inaugural instrument) produced low‑quality responses and were omitted from public reporting until methods are improved.

Tapered ending

Subcommittee members praised the presentation as a useful baseline for monitoring workforce trends and urged CHIA to return after the 2025 field period with updated findings. CHIA reiterated its objective role as a data provider and said subsequent cycles will allow trend analysis to inform policy and program decisions.