Double-Duty Caregivers in US Long-Term Care: Prevalence, Characteristics, and Job Outcomes

Objectives To examine the prevalence, demographic and employment characteristics, and job outcomes of double-duty caregivers in long-term care, compared with non–double-duty caregivers. Design Cross-sectional analysis of wave 1 (2024) of the National Dementia Workforce Study, a national online survey. Setting and Participants Assisted living facilities and nursing homes in the United States. Participants were sampled using a 2-stage cluster design to produce probability-based national estimates. The analytic sample included nursing staff (licensed nurses and unlicensed assistive personnel) in assisted living (weighted n=738,814) and nursing homes (weighted n=892,891). Methods The exposure was double-duty caregiver status, defined as providing unpaid care to an adult family member in addition to a professional caregiving role. We compared demographic, employment, and job outcome measures (burnout, intent to leave, job, and dissatisfaction) between double-duty and non–double-duty caregivers using χ tests and t tests. Results Overall, 23.6% of assisted living caregivers and 22.7% of nursing home caregivers reported double-duty caregiving. Double-duty caregivers were older and had more years of experience. In nursing homes, they were more likely to work nights and weekends and less likely to report irregular schedules; similar but nonsignificant patterns were observed in assisted living. Burnout was high across settings (>75%) and did not differ significantly by double-duty status. Intent to leave and overall job dissatisfaction were also similar between groups. Dissatisfaction was concentrated in compensation-related domains, and double-duty caregivers were more likely to report dissatisfaction with scheduling. Conclusions and Implications Double-duty caregiving is common among long-term care staff and may contribute to cumulative stress. Although overall job outcomes did not differ significantly by double-duty status, these caregivers exhibited distinct work patterns and greater dissatisfaction with certain workplace practices. The high prevalence of burnout underscores the need for organizational and policy interventions to support workforce well-being and care quality.