‘A Circular Nightmare’: Nursing Home Staffing Shortages Only Worsened as 2020 Came to a Close

Shortages of key nursing home staffers, including nurses and aides, accelerated from May to December 2020, prompting one consumer watchdog to warn that the worst of the long-term care crisis may be yet to come.

The total proportion of nursing homes reporting shortages in at least one staff category rose from 19.9% in May to 22.8% in December, according to a new report from the U.S. PIRG Education Fund — an arm of the nationwide U.S. Public Interest Research Group.

Understaffing of aides — including certified nursing assistants (CNAs), the backbone of direct caregiving in most facilities, as well as nurse and medication aides — was the most common workforce problem in the U.S. PIRG analysis, with 20.6% reporting shortages in December after a 17.4% rate in May.


Nurse shortages rose from 15% to 18.5% over that span; levels of clinical staffers such as doctors, physician assistants, and advance practice nurses held relatively steady with shortages of 2.3% in May and 2.6% in December.

The reasons for the shortages weren’t surprising: Overworked and underpaid to do a difficult job even before a global pandemic, frontline caregivers left the sector to find work with better pay and less risk to themselves and their families, the U.S. PIRG observed. In addition, workers who contracted the virus were forced to remain out of work, while many also took leave to care for sick relatives or children who were no longer attending in-person schools and day care centers.

Those factors led to a cascading series of failures that served to compound both nursing home outbreaks and staff strains.


“Not only are the shortages a direct result of the COVID-19 pandemic, experts say, but in a circular nightmare, the staff shortages also fueled more COVID outbreaks in nursing homes among residents and staff,” PIRG noted. “More cases mean more stress for workers, more workers who contract the virus or are exposed and then, even more staff shortages. The end result: In many cases, when there aren’t enough workers, patient care suffers.”

There’s also the less-discussed, but equally as important, psychological and mental toll that working at a nursing home during a pandemic can take on employees.

“Among staff, the stress of working in a nursing home during COVID has been crushing for many: There’s illness among residents, phone calls from families who can’t visit, residents who are incredibly lonely and beg for your time, residents who have no one besides you to hold their hand as they die and the constant fear of contracting the virus, particularly in homes without enough PPE,” the U.S. PIRG report observed.

The group called on lawmakers to provide more emergency funding for staff wages and personal protective equipment (PPE), publish public data on employee and resident vaccination rates, and ease restrictions on visitations to restore the informal caregiving services previously provided by family members.

Failure to reverse the trend could mean even more pain for a population devastated by the novel coronavirus; Harvard researcher Michael Barnett told U.S. PIRG that “the situation may erupt before the pandemic subsides.”

“It’s a recipe for a collapse in the workforce,” he told the group.

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