Nursing home workers among those most burdened by medical debt and related costs: study

Nearly 20% of nursing home workers have medical debt, a new study finds, placing them second highest among home health care workers and potentially jeopardizing their future careers.

The average medical debt of nursing home workers was more than $2,600, hundreds more than workers in home care, hospitals, clinics or offices. Overall, health care workers are more likely than workers in other sectors to have medical and educational debt, collectively owing more than $150 billion.

According to the study published Friday in the journal, “The highest medical debt was associated with being female, having lower income or education, working in home care or a nursing home, not having health insurance and having been recently hospitalized.” JAMA Health Forum.

“Educational and medical debt is associated with adverse health outcomes and may limit workers’ career mobility; reduce workforce diversity; and discourage workers from entering lower-paying fields” such as long-term care, wrote authors Kathryn E. Himmelstein, MD, PhD, and Alexander C. Tsai, MD, PhD, both of Massachusetts General Hospital and Harvard Medical School. “Health care workers who are indebted to their employers may be less able to address patient safety issues or protect themselves from workplace abuse.”

The study based health and education debt rates on the 2018–2021 Income and Program Participation Survey.

Himmelstein in an email to: “The study found that several previous studies suggest that employee debt—especially to an employer—may limit their ability to advocate for themselves or their patients.” McKnight’s Long-Term Care News. She cited a March 2023 lawsuit filed by the U.S. Department of Labor against a Brooklyn, New York, health care staffing agency seeking an injunction barring the company from forcing workers to sign three-year contracts or forcing them to repay “wages they rightfully earned.”

Himmelstein also pointed to a 2023 analysis filed as part of SEIU Pennsylvania’s antitrust case against UPMC, the largest health care provider in western Pennsylvania, that noted that 36% of responding employees reported medical debt to the company. The SEIU report noted that 51% of those in debt to UPMC were lower-wage workers, making $20 or less an hour, compared to respondents in the middle and upper income brackets.

“I think any employer practices that reduce the risk of employee debt, including comprehensive, low-cost health insurance, can help employees protect themselves and their patients,” Himmelstein said. McKnight.

Medical debt among health care workers was higher than among other workers, with an average of $1,567 — and a total of $19.8 billion nationwide, the study found. Women had more medical debt than men, and black workers had more medical debt than white workers.

The study also found that health care workers were more likely to have educational debt than workers in other sectors. Educational debt among all health care workers totals $134.4 billion nationally, with debt more common among black workers than white workers.

More than 23% of nursing assistants reported educational debt, while 18.7% reported medical debt. Among nursing assistants, the amount of educational debt was significantly higher, with nearly 35% reporting an average debt of $11,939. Fewer nursing assistants—12%—reported having medical debt.

“Extensive training requirements may lead to high student debt among some health care workers, while lay health care workers may be at risk for medical debt due to low pay and poor benefits,” the researchers wrote. “The reports highlight aggressive debt collection efforts by hospitals, including suing their own workers.”