Compensation Stability and Workforce Retention During COVID-19: A Paired Comparative Study of Home Care Nurses

Background/Objectives: Home care nurses play a vital role in maintaining continuity of care for vulnerable populations. However, the COVID-19 pandemic has exposed long-standing vulnerabilities in the workforce within home and community-based ser-vices. While compensation is often emphasized as a primary driver of workforce retention, less is known about how compensation satisfaction and retention intentions changed over time during a public health emergency. Methods: This study employed a cross-sectional survey with retrospective paired com-parisons among home care nurses employed at five home care agencies in Maryland. To assess temporal changes, respondents retrospectively evaluated compensation satisfac-tion, job satisfaction dimensions, and retention intentions before and during the COVID-19 pandemic. Paired samples t-tests were utilized to examine within-respondent differences across time periods. Herzberg’s Motivator-Hygiene Theory guided the inter-pretation of these changes in extrinsic and intrinsic workplace factors. Results: Compensation satisfaction did not differ significantly between the pre-pandemic and pandemic periods. In contrast, retention intentions changed significantly and were associated with organizational and preparedness-related factors, including leadership, communication, professional growth opportunities, financial stability, and perceptions of being well compensated. Several intrinsic job satisfaction dimensions improved during the pandemic, while resource-related challenges remained. Conclusions: The findings suggest that compensation stability alone was insufficient to secure workforce retention during the COVID-19 pandemic. Retention intentions were shaped by the interaction of financial security and organizational preparedness. Work-force policies to strengthen home care systems must combine compensation strategies with leadership development, professional growth pathways, and emergency prepared-ness planning to build resilience during future public health crises.