Nearly 20% of nursing home employees carry medical debt, placing them behind only home health workers and potentially threatening their future careers, a new study finds.
Nursing home workers’ mean medical debt amounted to more than $2,600, hundreds more than that of home health, hospital or clinic or office staff. Overall, healthcare workers are more likely than workers in other sectors to carry medical and educational debt, collectively owing more than $150 billion.
Medical debt, especially, was associated with being female, having lower income or education level, working in home health and nursing home care, a lack of health insurance, and recent hospitalization, according to a study published Friday in JAMA Health Forum.
“Educational and medical debts are associated with adverse health outcomes and may limit workers’ professional mobility; reduce workforce diversity; and discourage personnel from entering lower-paying fields,” such as long-term care,” wrote authors Kathryn E. Himmelstein, MD, and Alexander C. Tsai, MD, both affiliated with Massachusetts General Hospital and Harvard Medical School. “Healthcare workers indebted to their employers may be less able to address patient safety concerns or protect themselves from workplace abuses.”
The study based rates of medical and education indebtedness on the 2018-2021 Survey of Income and Program Participation.
The researchers said several prior investigations suggested worker indebtedness – particular to one’s employer – may reduce their ability to advocate for themselves or their patients, Himmelstein said in an email to McKnight’s Long-Term Care News. She pointed to a March 2023 lawsuit from the US Department of Labor against a Brooklyn, NY, healthcare staffing agency seeking to prohibit the company from forcing workers to sign three-year contracts or be forced to pay back “rightfully earned wages.”
Himmelstein also pointed to a 2023 analysis submitted as part of an antitrust case filed by SEIU Pennsylvania against UPMC, the largest healthcare provider in western Pennsylvania, which noted that 36% of responding employees reported owing medical debt to the company. The SEIU’s report noted that 51% of those in debt to UPMC were lower-earning workers, pulling in $20 or less per hour compared to mid- and high-wage respondents.
“I think that any employer practices that reduce workers’ risk of debt, including comprehensive low-cost health insurance, can help to empower workers to protect themselves and their patients,” Himmelstein told McKnight’s.
Medical debt among healthcare workers was higher than other workers with the mean amount sitting at $1,567 – and totaling $19.8 billion nationally, the study said. Women carried more medical debt than men, and Black workers had more medical debt than White employees.
The study also found that healthcare workers were more likely to carry educational debt than those in other sectors. Education debt among all healthcare workers totals $134.4 billion nationally with debt more common among Black employees than White employees.
Just over 23% of nurse aides reported educational debt, while 18.7% reported medical debt. Among RNs, the amount of educational debt was significantly higher with nearly 35% reporting holding a mean debt of $11,939. Fewer RNs – 12% – reported holding medical debt.
“Extensive training requirements may lead to high student debt among some healthcare workers, while nonprofessional health workers may be at risk for medical debt due to low wages and poor benefits,” the researchers wrote. “Reports have highlighted hospitals’ aggressive debt collection actions, including suing their own employees.”
