In September 2026, the Hamilton Project published research on movements into and out of US direct care jobs in long-term care settings. The analysis reports that fewer than half of these workers remain in the same type of job in the following year. Workers leaving for other employment tend to obtain higher wages and greater access to employer-sponsored health insurance and pensions. Published on 29 September, the study concerns employment patterns observed before publication, rather than a new change in benefit rules.

The findings are descriptive. Workers who leave may differ from those who stay in qualifications, family responsibilities, hours or access to alternative employers. The research does not isolate the effect of offering a pension or health plan. Nevertheless, it gives benefits teams a concrete reason to examine the entire employment offer when discussing care-sector retention.

Evaluate access as well as the benefit list

An employer can advertise health cover while excluding workers whose hours fluctuate or whose status makes them ineligible. Participation may also be constrained by employee contributions, waiting periods, provider access or a difficult enrolment process. Retirement saving raises related questions about eligibility, employer contributions and whether employees understand what they receive. A comparison of benefit brochures will miss many of these differences.

This editor recommends building a job-group inventory that records offered benefits, eligibility, actual enrolment and employee cost alongside wages and working hours. That inventory should identify what happens when a worker changes shifts, reduces hours or moves between sites. The purpose is to find practical gaps, without assuming that every departure can be solved through additional insurance.

Build a credible retention evaluation

A useful employer analysis would begin with turnover by role, site and tenure, then compare those patterns with benefit access and changes in the employment package. Exit interviews can identify concerns, but they may omit people who cannot be contacted or who prefer not to explain their departure. Where possible, combine that evidence with records of take-up, eligibility losses and the time needed to resolve benefit queries.

If a provider changes its package, the evaluation should account for concurrent pay increases, staffing changes and local labour-market conditions. A pilot or phased implementation may offer a more informative comparison than a simple before-and-after turnover rate. The board should ask what evidence supports attribution, how long any improvement lasts and which groups remain difficult to retain.

Insurers and brokers can improve the comparison

Benefits advisers can help employers price alternative contributions and coverage designs, but procurement should examine usable protection rather than the lowest quoted premium alone. Service for workers outside conventional office hours may be particularly relevant. Communications should explain eligibility and access in language employees understand, while providing support for people who cannot easily use a portal.

For health insurers, better retention is a possible employer objective, not an established consequence of a product sale. Any business case should distinguish employee satisfaction, continued employment, clinical access and insurance claims. A programme can improve one outcome without improving all four. Aggregated reporting should protect medical confidentiality and avoid giving managers unnecessary information about individual treatment.

Apply the lesson locally

Multinational employers cannot transfer the US relationship between employment and health insurance directly to every country. Statutory coverage, pension participation, collective agreements and employment contracts vary. Central teams can use a common set of questions while allowing local advisers to explain the relevant protection gaps. The comparison should include wages, working conditions and career opportunities, since benefits operate within that wider offer.

For directors overseeing a care business, persistent turnover can affect staffing continuity, service reliability and operating costs. A concise board pack should connect departures, vacancies and total rewards, with named owners for corrective actions. The Hamilton Project findings provide a starting point for that review. Whether a redesigned package improves retention must be demonstrated with the employer’s own evidence.