As August 2022 came to a close, there were hopeful signs for the beleaguered nursing-home industry. Long beset by staffing shortages – shortages that were exacerbated by the pandemic – the sector saw 12,000 new hires join the ranks during the month.
The investment research and financial media firm Hedgeye Risk Management viewed that as a sign that the nursing-home labor shortage had bottomed out, and that better things lie ahead. Certainly there are miles to go, though.
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Research compiled by the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) showed that from February 2020 (i.e., before the pandemic hit the U.S.) until July 2022, some 223,700 nursing-home workers left their jobs, leaving behind a workforce consisting of a little over 1.3 million. According to the AHCA/NCAL, that’s the fewest since 1994.
When residential care facilities are also taken into consideration, there were over 362,000 fewer workers in the sector than in February 2020. That left a little over three million, the fewest since 2008.
NCAL Executive Director LaShuan Bethea told McKnight’s Senior Living that the labor shortage constitutes a “crisis,” and American Seniors Housing Association President David Schless told that same outlet that it is “the greatest workforce shortage in history.” Those thoughts were echoed by Brian Jurutka, President and CEO of the National Investment Center for Seniors Housing and Care, who told McKnight’s, “Labor is the “No. 1, No. 2 and No. 3 top issue right now. While it was certainly an area of concern before the pandemic, the pandemic added fuel to the fire.”
The AHCA/NCAL reported in June that nearly half of the nation’s 14,000 nursing homes are facing severe labor shortages, and 73 percent of those facilities are concerned about closing. Beth Martino, the organization’s Senior Vice President of Public Affairs, told U.S. News and World Report that as many as 400 nursing homes could in fact be shuttered this year.
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Again citing AHCA/NCAL data, six of every 10 facilities have had to limit admissions, seven in 10 have had to rely on temporary workers and nearly every one of them has asked staff to work overtime. Increased hours also increase the possibility of burnout and errors, which in turn can lead to worse outcomes.
The challenges faced by the Minnesota-based Evangelical Good Samaritan Society are all too typical. That organization, which according to the Minnesota Post is the nation’s second-largest non-profit senior living care provider, had by December 2021 doled out a staggering $6.73 million to staffing agencies, so that it might fill the breach at its 31 assisted living communities and 28 nursing homes, as well as within its home health and hospice services.
The organization’s budget, however, was $690,000, so its current course is “simply not sustainable,” as Regional Executive Director Mike Deuth told the Post.
Another example is the situation faced by facilities in New York State’s Finger Lakes Region. Mary Zelazny told the Finger Lakes Times that it is “as bad as I’ve ever seen it,” and there were suggestions that improved training and attempts to diversify the workforce would go a long way toward solving the problem. More significant, however, was the commitment of $10 billion over the next five years to the healthcare sector by Gov. Kathy Hochul, with the goal of growing the workforce by 20 percent.
Similar steps have been taken in Minnesota. Again quoting the MinnPost, Gov. Tim Walz has approved $50 million for hiring and retention bonuses in the healthcare sector, and state Republicans have proposed a $150 million plan that would specifically address the challenges facing nursing homes.
Certainly federal intervention is much-needed, and to that end President Joseph R. Biden introduced new guidance for nursing-home staffing before his State of the Union Address in March, which has since been embraced by the Centers for Medicare and Medicaid Services. Specifically, the CMS will monitor such issues as the presence of registered nurses and licensed nurses at various facilities.
The AHCA/NCAL’s Care for our Seniors Act proposes student-loan forgiveness for new hires and tax credits for those already established in the long-term-care field, as well as the development of programs that will assist professionals in finding affordable housing and suitable childcare assistance. Finally, the act proposes that those colleges and universities that see their graduates spend five years or more in the sector be granted certain subsidies.
Other ideas abound. Schless suggests that immigration reform might broaden the talent pool, and David Voepel, CEO of the Arizona Health Care Association, told McKnight’s that in his home state funding has been allocated for a program that aids the recruitment, training and retention of certified nursing assistants.
Not to be forgotten, either, is the impact technology is having (and will continue to have) on the sector. One of the many examples of these time-saving (and ultimately life-saving) tools is artificial intelligence, which is useful in automating image diagnoses, reducing dosage errors and easing clinicians’ administrative burdens.
Certainly staffing issues are not going away anytime soon. McKnight’s notes that in the decade ending in 2028, some 8.2 million more caregiving positions will open up – 6.9 million as a result of worker departures, the other 1.3 million because of job creation. And the AHCA/NCAL believes staffing levels will not be as adequate as they once were until 2026. As a result, new measures and new ideas will forever be welcome in this sector, as the U.S. population continues to age, bringing with it increased demands and increased challenges.
Photo: Kiwis, Getty Images
Editor’s Note: Like many other hospices, the author’s employer is a member of the American Health Care Association and the National Center for Assisted Living.
Melissa Powell is the executive vice president and chief operating officer of Genesis HealthCare. She was previously president and chief operating officer of The Allure Group, a New York City-based nursing home operator. Melissa has 20 years of experience coordinating, assessing and improving senior care utilizing a market-focused model in New Jersey and New York.
