{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:03:05Z","timestamp":1791666185186,"version":"4.3.4"},"reference-count":16,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T00:00:00Z","timestamp":1589414400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL107240"],"award-info":[{"award-number":["R01HL107240"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["U01AG027669"],"award-info":[{"award-number":["U01AG027669"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>Long\u2010term care (LTC) facilities are particularly dangerous places for the spread of COVID\u201019 given that they house vulnerable high\u2010risk populations. Transmission\u2010based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers\u02bc second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs, and (2) unpaid care work for dependent children and\/or adult relatives (double\u2010 and triple\u2010duty caregiving) overall and by occupational group (registered nurses [RNs], licensed practical nurses [LPNs], or certified nursing assistants [CNAs]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>A descriptive secondary analysis of data collected as part of the final wave of the Work, Family and Health Study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING<\/jats:title>\n                    <jats:p>Thirty nursing home facilities located throughout the northeastern United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PARTICIPANTS<\/jats:title>\n                    <jats:p>A subset of 958 essential facility\u2010based LTC workers involved in direct patient care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MEASUREMENTS<\/jats:title>\n                    <jats:p>We present information on LTC workers\u02bc demographic characteristics, health, features of their LTC occupation, additional paid work, wages, and double\u2010 or triple\u2010duty caregiving roles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Most LTC workers were CNAs, followed by LPNs and RNs. Overall, more than 70% of these workers agreed or strongly agreed with this statement: \u201cWhen you are sick, you still feel obligated to come into work.\u201d One\u2010sixth had a second job, where they worked an average of 20\u2009hours per week, and more than 60% held double\u2010 or triple\u2010duty caregiving roles. Additional paid work and unpaid care work characteristics did not significantly differ by occupational group, although the prevalence of second jobs was highest and accompanying work hours were longest among CNAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>LTC workers commonly hold second jobs along with double\u2010 and triple\u2010duty caregiving roles. To slow the spread of COVID\u201019, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports. J Am Geriatr Soc 68:1657\u20101660, 2020.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.16509","type":"journal-article","created":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T08:00:32Z","timestamp":1587974432000},"page":"1657-1660","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":108,"title":["Essential\n                    <scp>Long\u2010Term<\/scp>\n                    Care Workers Commonly Hold Second Jobs and Double\u2010 or\n                    <scp>Triple\u2010Duty<\/scp>\n                    Caregiving Roles"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0783-1611","authenticated-orcid":false,"given":"Courtney Harold","family":"Van Houtven","sequence":"first","affiliation":[{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System  Durham North Carolina USA"},{"name":"Department of Population Health Sciences and Duke\u2010Margolis Center for Health Policy Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"DePasquale","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1228-0938","authenticated-orcid":false,"given":"Norma B.","family":"Coe","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine, University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,14]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"HealyJ KovaleskiS.The coronavirus\u02bcs rampage through a suburban nursing home.New York Times. March 21 2020."},{"key":"e_1_2_6_3_1","volume-title":"Long\u2010Term Care Services in the United States: 2013 Overview","author":"Centers for Disease Control and Prevention","year":"2013"},{"key":"e_1_2_6_4_1","unstructured":"StricklerL.Number of long\u2010term care facilities with COVID\u201019 cases tops 400 nationwide.NBC News. 2020."},{"key":"e_1_2_6_5_1","unstructured":"ArcoM.Half of N.J.\u02bcs 375 nursing homes have coronavirus cases. Health officials planning statewide coordinated response.NJ.com. April 7 2020."},{"key":"e_1_2_6_6_1","unstructured":"StricklerL KhimmS. Coronavirus deaths in U.S. nursing homes soar to more than 5 500. 2020.https:\/\/www.nbcnews.com\/news\/us-news\/coronavirus-deaths-u-s-nursing-homes-soar-more-5-500-n1184536. Accessed April 16 2020."},{"key":"e_1_2_6_7_1","unstructured":"BrownD.Long\u2010term care deaths due to COVID\u201019 soar to more than 5 500; healthcare workers represent almost 20% of coronavirus cases.McKnights Long\u2010Term Care News. 2020.https:\/\/www.mcknights.com\/news\/long-term-care-deaths-due-to-covid-19-soar-to-more-than-5500-healthcare-workers-represent-almost-20-of-coronavirus-cases\/. Accessed April 16 2020."},{"key":"e_1_2_6_8_1","volume-title":"Long\u2010term Care Providers and Services Users in the United States, 2015\u20102016","author":"Harris\u2010Kojetin L","year":"2019"},{"issue":"2","key":"e_1_2_6_9_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/geronb\/gbu139","article-title":"Combining formal and informal caregiving roles: the psychosocial implications of double\u2010and triple\u2010duty care","volume":"71","author":"DePasquale N","year":"2016","journal-title":"J Gerontol B Psychol Sci Soc Sci."},{"key":"e_1_2_6_10_1","unstructured":"JamesE GelladW HughesM. In This Next Phase of Health Reform We Cannot Overlook Long\u2010Term Care. Health Affairs Blog March 16 2017. http:\/\/allh.us\/PCWc."},{"key":"e_1_2_6_11_1","volume-title":"Occupational Outlook Handbook, Nursing Assistants and Orderlies","author":"Bureau of Labor Statistics","year":"2020"},{"key":"e_1_2_6_12_1","unstructured":"OhS.The future of work is the low\u2010wage health care job. VOX. 2017.https:\/\/www.vox.com\/2017\/7\/3\/15872260\/health-direct-care-jobs. Accessed April 16 2020."},{"issue":"6","key":"e_1_2_6_13_1","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1377\/hlthaff.2019.00021","article-title":"Home and community\u2010based workforce for patients with serious illness requires support to meet growing needs","volume":"38","author":"Spetz J","year":"2019","journal-title":"Health Aff"},{"key":"e_1_2_6_14_1","doi-asserted-by":"crossref","DOI":"10.3768\/rtipress.2013.mr.0024.1303","volume-title":"An Integrative, Multilevel, and Transdisciplinary Research Approach to Challenges of Work, Family, and Health","author":"Bray J","year":"2013"},{"key":"e_1_2_6_15_1","first-page":"402","article-title":"Changing work, changing health: can real work\u2010time flexibility promote health behaviors and well\u2010being?","volume":"52","author":"Moen P","year":"2011","journal-title":"J Health Soc Behav"},{"key":"e_1_2_6_16_1","doi-asserted-by":"crossref","DOI":"10.4324\/9781315083865","volume-title":"Working Couples Caring for Children and Aging Parents: Effects on Work and Well\u2010Being","author":"Neal M","year":"2017"},{"issue":"6","key":"e_1_2_6_17_1","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1377\/hlthaff.2018.05514","article-title":"Care for America\u02bcs elderly and disabled people relies on immigrant labor","volume":"38","author":"Zallman L","year":"2019","journal-title":"Health Aff"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.16509","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16509","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.16509","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16509","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:10:58Z","timestamp":1762189858000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.16509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,14]]},"references-count":16,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1111\/jgs.16509"],"URL":"https:\/\/doi.org\/10.1111\/jgs.16509","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,14]]},"assertion":[{"value":"2020-04-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-04-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}