CHIA survey: high nurse and direct-care vacancies, organizations limiting intakes

Members of the Workforce Support Subcommittee of the Massachusetts Commission on the Status of Persons with Disabilities heard a presentation from the Massachusetts Center for Health Information and Analysis (CHIA) on findings from CHIA's 2023 healthcare-sector survey and the 2024 human-services survey, which together show high vacancy and turnover rates for registered nurses (RNs) and direct care workers and evidence that many providers have limited new intakes because of staffing shortages.

CHIA deputy executive director for research Zee (identified in the presentation as the deputy executive director for research at CHIA) opened the briefing and said the agency's mission is to "collect and provide a reliable and objective analysis on all health care related issues and challenges." CHIA's presentation described survey fielding, response rates, and a Tableau dashboard that breaks results down by sector and occupation.

Why this matters: CHIA's cross-sector results indicate workforce shortages are affecting service access. CHIA reported that many organizations have increased patient waiting lists or limited new intakes, particularly in behavioral health and home health settings, and that those operational adjustments are being used to cope with staffing deficits.

Key findings

- Survey timing and scope: CHIA said the healthcare-sector survey was fielded May 2023'January 2024 and covered hospitals, nursing homes, home- and community-based providers, behavioral health, community health centers, dental practices, EMS, ambulatory surgical centers and public hospitals. The human-services survey was fielded July'September 2024 and included 64 state operators and 197 private operators; CHIA said responses were weighted to represent all human-service organizations in the state.

- Occupations most affected: Across the healthcare sectors, registered nurses and physicians were concentrated in acute care; licensed practical nurses and direct care workers were concentrated in nursing homes and long-term care. In human services, CHIA reported that Direct Care Worker categories made up a large share of employee composition for both state and private operators.

- Vacancy and turnover data: CHIA told the subcommittee that RN vacancy rates were highest in home health and nursing homes. The presentation highlighted a 47% RN turnover rate in adult day health (reported by CHIA during the briefing), with home health and nursing homes also showing high turnover. 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 especially high for caseworkers in the private operator sample.

- Impacts on access: A majority of organizations across sectors reported increases in the volume of people waiting for services; most organizations reported limiting new intakes or patients in the prior 12 months, particularly in behavioral health and home health.

- Recruitment and retention drivers: CHIA reported that shortage of eligible applicants and noncompetitive salaries were the most commonly selected challenges for recruiting RNs and other roles. For retention, CHIA listed abuse or lack of respect, burnout, and inflexible scheduling among the frequent challenges reported for RNs, especially in acute and public hospitals.

- Employer strategies: CHIA said the most commonly reported strategies to recruit and retain staff were increasing wages, flexible scheduling, and sign-on or referral bonuses. "Increasing wages was something that I think we saw across all," CHIA associate director for research Haley said during the presentation.

- Compensation data quality and 2025 plans: CHIA said it attempted to collect wage and benefits data in the inaugural cycle but that responses were incomplete or low quality, so compensation data were not included in the published results. For the 2025 survey cycle CHIA described instrument refinements: collecting starting and average hourly wages for a narrow set of occupations (direct care workers and registered nurses), measuring overtime as a share of hours, moving from FTE counts to total hours for some measures, and adding clearer occupation definitions. CHIA said it launched the first cohort of the 2025 fielding, with a target for field completion by June and analysis between July 2025 and January 2026, and an aim to release results in January 2026.

Method and limitations

CHIA emphasized that most survey responses were submitted by HR directors or administrators answering on behalf of organizations; the presentation noted that reported reasons for turnover or recruitment challenges reflect organizational reporting (for example, exit interviews) rather than direct surveys of frontline staff. CHIA also cautioned it omitted compensation results from the published dashboard because the wage and benefits responses did not meet quality thresholds.

Questions and follow-up

Subcommittee members asked for clarifications on occupation definitions (for example, distinguishing independent licensed clinicians from nonindependent clinicians and the levels of direct care workers), medication administration by direct care staff, and differences in pay between state and private operators. CHIA said it would share the definitions used in the instrument and welcomed feedback on refining occupation categories. CHIA presenters noted the state's Medication Administration Program (MAP) as one existing certification model for training direct care staff to administer medication under nursing supervision. CHIA also said it receives data from state HR sources for public-sector employees and may supplement survey results with external benchmarks where needed.

Next steps

CHIA and the subcommittee discussed using the 2025 survey to improve wage and benefit measurement, to continue monitoring trends biannually, and to share refined definitions and the dashboard so stakeholders can use the findings for policy and planning. The subcommittee chair said the presentation would be shared with full committee members and that the subcommittee is planning a future panel (targeted for April or May) featuring employees with disabilities and related job supports.

Ending

CHIA closed the presentation by saying the agency aims to maintain objective, reliable data to inform policy and program decisions and noted the value of a second data point in 2025 to track trends over time. The subcommittee thanked CHIA for the briefing and requested follow-up materials, including occupation definitions and the dashboard link.