• Posted June 29, 2022

Staffing Shortages Have U.S. Nursing Homes in Crisis

There's a shortage of nursing home beds for the elderly in America due to a severe staffing crisis that has caused long-term care facilities to cut back on new admissions, new research shows.

Three out of five nursing homes (61%) have limited new admissions due to staffing shortages, according to a survey conducted by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) of 759 nursing home providers.

And nearly three out of four (73%) are concerned that they'll have to close their facilities over staffing problems, the survey found.

"We project that more than 400 nursing homes could close this year due to this workforce and economic crisis," said Beth Martino, senior vice president of public affairs for the AHCA/NCAL.

These factors could leave some elderly bereft of the care they need as they age.

"One administrator in Kansas recently told me he's got a waiting list of residents, but not enough staff to admit," said Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services.

"He's contracted with four staffing agencies, but not one can provide a licensed registered nurse. His story is not unique," Sloan said. "Across the country, providers are being forced to pare back admissions. Some of our members say the situation is increasingly unsustainable."

The AHCA/NCAL survey found that 87% of nursing home providers are facing moderate to high staffing shortages, with nearly half (48%) struggling with a severe staffing shortage.

Nearly all providers said they are having trouble hiring staff (98%), and as a result are asking staff to work overtime or extra shifts (99%).

"I have never been to a place which was fully staffed yet," Diondre Clarke, a traveling certified nurse assistant in Charlotte, N.C., told CBS News.

Clarke said she sometimes has to look after 20 or more residents during a shift, which leaves staff struggling to provide good care to residents.

Pandemic added strain

The staffing among nursing homes has been tight for quite some time, Martino said.

"For decades, Medicaid has notoriously underfunded nursing home care, and this chronic underfunding left long-term care providers struggling to compete for qualified, dedicated caregivers," she said. "We have been calling for help for years."

But the COVID-19 pandemic "really turned these challenges into a historic crisis," Martino added. "Nursing homes have lost more than 240,000 caregivers, or roughly 15% of its workforce, since the beginning of the pandemic. This is worse than any other health care sector.

"The pandemic has caused increased burnout among caregivers, especially in long-term care, where many feel forgotten or blamed by public officials and the public for COVID," Martino continued. "The Great Resignation has made it difficult for long-term care providers to recruit replacements and to compete against other employers, especially because of chronic Medicaid underfunding."

Medicaid is the primary payer for the "long-stay" nursing home residents who take up more than 80% of the beds in skilled nursing facilities, according to LeadingAge.

States set Medicaid reimbursement rates based on how much they want to spend on the program, rather than the actual cost of care in nursing homes, LeadingAge said.

"The Medicaid reimbursement rate is $189 a day. In 2021, our actual care costs per day were $412," said LeadingAge member Jonathan Hollinger, president and CEO of Pleasant View Communities in Manheim, Pa. "The state's reimbursement rate does not even cover 50% of the costs, which leaves us to make up the deficit."

More than 70% are leaning on temp staffers to care for residents, the survey found. That's only adding to the crunch, because "staffing agencies are charging two to three times more than pre-pandemic rates," Martino said.

Nine out of 10 nursing home providers have offered increased wages and bonuses to attract new employees, but 76% said their current financial situation and lack of funding is an obstacle to offering competitive wages.

But money's only part of the problem, said Robyn Stone, senior vice president of research for LeadingAge.

Their research has found that high turnover rates pre-COVID were caused by two major reasons, "poor supervision, followed by low wages," Stone said.

"We've found that for front-line workers (certified nurse aides), turnover rates can be improved by providing better training, continued on-the-job support as well as wrap-around services such as child care, transportation and food security," Stone said.

"We know that 60% to 80% of work in nursing homes is performed by front-line professionals. They're misunderstood and undervalued," Stone continued. "But money is only one part of the equation. Caregiving as a skill is also held in low regard, with little recognition of the education and knowledge required to do this work. The reality is that this is complex work; these are professional caregivers with job responsibilities that demand a higher wage."

Fixing the problem

Projections show that as many as 8.2 million staffing jobs in long-term care will need to be filled by 2028 as the U.S. population ages, LeadingAge says.

LeadingAge has proposed a multi-pronged approach for boosting the long-term care workforce. Their strategies include expanding the pipeline for training caregivers, strengthening education and training, facilitating career advancement among staff, and increasing compensation.

But strategies like those will require more funding, Martino said.

"We need a national and local commitment to invest in our nation's seniors and their caregivers," she said. "Federal and state public health officials need to prioritize long term care for resources, as well as fully fund seniors' care. But we also need a more long-term solution to help recruit and retain the next generation of caregivers and to prepare for a growing elderly population.

"Some in Washington are proposing we simply raise staffing standards, but this fails to get at the heart of the problem," Martino continued. "Nursing homes would love to hire more nurses and nurse's aides, but we can't meet increasing staffing requirements if we can't find people to fill the open positions, nor if we don't receive corresponding government funding and support."

More information

The American Health Care Association/National Center for Assisted Living has more about nursing home closures, while LeadingAge has more about the challenges older adults face accessing aging services.

SOURCES: Beth Martino, senior vice president, public affairs, American Health Care Association/National Center for Assisted Living; Katie Smith Sloan, president and CEO, LeadingAge; Jonathan Hollinger, president and CEO, Pleasant View Communities, Manheim, Pa.; Robyn Stone, senior vice president, research, LeadingAge; CBS News