Skilled Nursing Operators Competing Against Other Health Settings for Workers — Not Starbucks

Nursing home operators continue to struggle with attracting and keeping skilled health care workers, a problem that negatively affects quality of care and the bottom line.

And while it’s not easy to come up with solutions to this global issue, staffing obstacles persist — and they’re only going to get worse, according to a recent survey conducted by the Cleveland-based software company OnShift.

In an era of historically low unemployment and rising minimum wages, many post-acute and long-term care operators have placed the blame for high turnover on competition from retail and foodservice jobs — which offer similar wages and benefits in a potentially less taxing setting.


But retail competition trails behind a bigger foe — other operators within the health care industry itself, according to OnShift.

Skilled nursing providers reported most competition from senior care organizations and hospitals, with even home health outstripping the category of hotel/retail/”gig economy”:

Source: OnShift
  • Senior care organizations: Nearly 90%
  • Hospitals and health systems: More than 70%
  • Home health agencies: Greater than 50%
  • Hotels, restaurants, retail, “gig economy”: A little over 40%

The skilled nursing answers compare to the more than 70% of senior living players below who identified hotels and other hospitality sectors as a major source of competition, which fell only behind other senior care organizations:


The results encompass responses from more than 1,500 senior housing and care professionals, collected during the fall of 2019.

In the category of retaining employees, 63% of all respondents reported a problem, with 73% indicated that locating qualified employees was at the top of their woes. And 68% revealed that employee turnover coincides with decreased continuity of care — along with 44% agreeing that resident satisfaction decreases with high turnover.

When asked for an outlook on workforce challenges over the next three years, 72% responded that finding qualified employees will remain the same or worsen.

Respondents believed some of the biggest problems for their employees included juggling several jobs (69%), childcare issues (59%), added responsibilities (50%), and a lack of savings (50%) — all factors contributing to personal stress.

These stressors often resulted in reports of increased absences (80%) and decreased enthusiasm and work satisfaction (59%). In addition, HR participants reported “strained employee-manager relationships” (41%) as a consequence of employees being spread too thin.

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