Nursing Home Employment Numbers Slide Again in November

The nation’s nursing homes lost about 1,700 jobs in November, marking two consecutive months of slight slides since the introduction of the new Medicare payment model for skilled nursing services.

The federal Bureau of Labor Statistics (BLS) counted a seasonally-adjusted total of 1,603,500 employees at nursing care facilities last month, a drop of 1,700 from the 1,605,200 in October — itself a 1,300-worker decline from September.

For comparison, the only other health care category with job losses was dental offices, which shed 2,400 jobs in November on a seasonally-adjusted basis. The health care space as a whole added 45,200 positions last month, the BLS found; home health agencies saw 8,500 new workers during that span.


“In November, health care added 45,000 jobs, following little employment change in October (+12,000),” the BLS noted in its most recent jobs release. “The November job gains occurred in ambulatory health care services (+34,000) and in hospitals (+10,000). Health care has added 414,000 jobs over the last 12 months.”

Nursing home layoffs have made headlines in the immediate aftermath of the new Patient-Driven Payment Model (PDPM) for Medicare reimbursements, particularly among physical and occupational therapists. With a newfound emphasis on resident acuity and not volume of hours, PDPM has prompted many operators and third-party therapy providers to change strategies by boosting the use of group and concurrent services — while also reducing headcounts.

A recent SNN survey found that 43% of nursing home and therapy-company operators had laid off at least a portion of their therapy workforces post-PDPM, with a plurality reporting cuts of 20% or less. In addition, only 16% indicated that they’d implement more layoffs going into the new year.


That said, the two months of negative numbers may not portend a significant shift in employment patterns in an industry still generally plagued by workforce shortages, particularly among specialists and frontline caregivers. For comparison, the space employed a recent peak of 1,610,200 in September 2019, but that figure represented a slight gain from the 1,607,000 in November 2018.

Several analysts noted that the October decline of 1,300 jobs was slight given the overall size of the workforce, while Chad Vanacore of investment banking firm Stifel noted that BLS data doesn’t provide a clear breakdown of positions within the job-loss figures.

“You don’t know the percentage of CNAs, certified nurses , administrators, or therapists, so it’s hard to say if there were major therapy cuts due to PDPM,” Vanacore said last month. “Any cost savings you can garner has to come from therapy employment, and it should be expected that there is a certain reduction in therapists. It all boils down to supply and demand, and there’s a bigger demand for nurses because there’s still a nurse shortage.”