Caught in the Middle: What Happens When Frontline Workers Leave the Workforce?

We recently discussed COVID burnout, when healthcare workers on the frontline of the pandemic response choose to leave the industry rather than continue shouldering the burden of an unending health crisis. But COVID is affecting these workers in other ways too: Many also need to provide care for their own children and parents. And the stress this care can create often makes a public health crisis even worse.

The Sandwich Generation

Parents who have young children while also caring for aging relatives are part of what is known as the "sandwich generation." Currently, 12% of parents with children under 18 are simultaneously providing unpaid care for an aging adult, be it help with such in-home activities as dressing, eating and housework or transportation to and from appointments. All told, these parents average more than an hour per day providing adult care, and spend more time doing housework and errands and sacrificing more sleep than parents not providing such care. Millions of parents in the United States fall into the sandwich generation, and given the demographic trends of an aging society and delayed parenthood, this number is expected to increase.

Time isn't the only resource sandwich generation parents are depleting. Forty-nine percent of these parents have spent at least $1,000 of their own money to care for aging relatives. In addition, they spend nearly 90 fewer minutes per day on paid work, resulting in less income to take on those extra expenses. Especially after considering the financial pressure this creates, it's no wonder 71% of sandwich generation parents described tending to both young children and older adults as "somewhat stressful" or "very stressful."

The COVID-19 pandemic has only exacerbated this crisis. Beyond the more than 700,000 deaths in the United States attributable to the coronavirus, the pandemic has had several health and societal repercussions that stretch these parents even more:

• While no age group is immune from the coronavirus, it hit older adults the hardest. According to the CDC, the risk of becoming severely ill following exposure to COVID increases for those in their 50s, 60s, 70s and 80s, with those 85 and older at the highest risk. The elevated incidence of COVID-related illness among the aged translates into a need for more care from their middle-aged children.

• The summer of 2021 saw the rise of the Delta variant of COVID-19, which correlated with a nearly five-fold increase in weekly COVID-19-associated hospitalization rates among children and adolescents.

• In response to the coronavirus pandemic, schools around the country instituted virtual learning which some schools maintain today. Virtual learning has forced some parents to find ways to remain home to mind their children during the school day.

Healthcare Workers Caught in the Middle

The pressures of providing care have been especially felt by frontline workers during the pandemic. Healthcare workers are fighting the pandemic on two fronts. Primary is the number of people who acquire COVID and require medical intervention: At its height in the winter of 2020-2021, medical facilities saw more than 100,000 new cases per week, and the recent Delta variant in the summer of 2021 increased that number from fewer than 20,000 cases per week to more than 80,000. People are also putting off proactive healthcare measures for fear of contracting the virus, which means conditions and illnesses that could have been prevented or at least diagnosed early require longer and more intensive healthcare measures.

The additional burden placed on sandwich generation healthcare workers has resulted in an increase in the large swath of talent leaving the workforce — something the healthcare industry is not equipped to deal with. If average middle management turnover was 10% to 15% but is now 20%, that's a dramatic surge when qualified caregivers are already in short supply. Healthcare positions that used to take three to five months to backfill can now take six to nine months, making finding qualified replacements just as hard, if not harder, than when the pandemic began.

So what can healthcare industry leaders do? While there are no easy answers, some forethought and flexibility might help ease the crisis:

• Identify the stress points in your organization. Be aware of where you're weakest — where one or two key departures could put your organization in a logistical bind. What can you do proactively (perhaps even procedurally) in the event a member of your team needs to reduce hours? It's far better to start engineering solutions now, while you have the time and space to consider various possibilities, than after the need has presented itself.

• Try to anticipate. If you have a vacancy, how can you fill it with a combination of seasoned talent (for specialist responsibilities) and newer talent (for more routine responsibilities)? How can you maintain expertise? How quickly — and realistically — can you replace it? People are course-correcting daily due to unanticipated changes to family care. Sometimes vacancies open up literally overnight. In those instances, you might not have time to fill the position from scratch. We all have to anticipate what the trend lines look like and understand that people are being called on to support their families more and more.

• Think outside the box. Look for unorthodox solutions. Perhaps specialists who leave the workforce could come back or be utilized in a different fashion — as mentors, for example, as consultants, or on a part-time basis. Does on-site child care or adult care give your employees more flexibility for work? Experts who've been in the trenches add value immediately — don't let that institutional knowledge go without exhausting every option first.

Perhaps the most important step you can take now is building your relationships with your teams. Take advantage of opportunities to support team members in what has become an increasingly stressful job. Doing so might not only alleviate the pressures they're feeling now, but it could also make them more likely to find ways to work with you should they need to reduce their hours to care for family.