Nationwide Nursing Home Employment Creeps Up for First Time Under PDPM

After several consecutive months of declines, the nursing home industry actually added jobs in January, the first month of employment growth since the implementation of a new Medicare payment system last October.

The nation’s nursing care facilities brought on 2,400 workers in the first month of 2020, according to the regular monthly employment report from the federal Bureau of Labor Statistics (BLS).

While that number represents just a fraction of the nearly 1.6 million people who work at nursing homes and other similar care sites across the country, it’s the industry’s first trip into the black for employment numbers since the Patient-Driven Payment Model (PDPM) took effect in October.


The sector shed jobs in each of the last three months of 2019, with the losses starting at 1,300 in October and accelerating to 6,700 in December.

The arrival of PDPM, which rewards operators for focusing on resident condition instead of the total volume of therapy minutes provided, spurred confirmed and anecdotal reports of layoffs across the common therapy disciplines in skilled nursing facilities — physical, occupational, and speech.

A full 43% of respondents to a non-scientific SNN reader poll in December reported that they had laid off some number of therapists in the wake of the payment change; most indicated that the staffing reductions affected up to 40% of their total therapy workforce. A further 53% indicated that they had shifted therapists to PRN status, a term for as-needed employees that do not work on a set schedule.


The BLS statistics are not a perfect snapshot of PDPM’s effects on nursing home staffing: For one, the figures do not indicate which specific type of jobs are gained or cut, and even the peak job loss figure of 6,700 represented less than 1% of the overall national workforce.

The wider health care industry continued to show robust job growth, adding 35,500 positions in January. Hospitals saw the fastest expansion with a net gain of 9,700 jobs, while “community care facilities for the elderly” was the only health care category with any kind of loss in the month, shedding 1,700 positions.

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