U.S. Nursing Home Workforce Shrank by 11.5% Since Start of Pandemic

The nation’s nursing homes have shed 182,000 jobs since the start of the COVID-19 pandemic in February 2020, according to a new analysis, a significant drop for a sector that struggled to keep facilities fully staffed even in pre-COVID times.

That works out to an 11.5% drop between February 2020 and the end of last month, the non-profit health care consulting firm Altarum found in a look at health care employment trends released this week.

The toll on nursing home employment stands in contrast with the wider health care system, which currently has about 3.5% fewer jobs than at its peak last February. Even within the context of long-term care facilities, nursing homes are lagging behind: Residential care settings saw an increase of 4,800 jobs last month, while nursing homes dropped 11,600 positions.


Employment at all nursing and residential centers combined has fallen 9.2% since last February, a loss of 310,000 jobs.

“The economy overall added a strong 379,000 jobs in February,” Altarum observed. “Total employment remains 6.2%, or about 9.5 million jobs below February 2020 peak employment. The unemployment rate dropped slightly to 6.2%.”

Staffing has been a significant issue at nursing homes for years. Between 2017 and 2018, median turnover at facilities was 94%, a study published earlier this month determined — with even higher levels at the lowest-rated facilities on the federal government’s five-star scale.


The pandemic further exposed the dangers of undermanned facilities: While staffing coverage does not appear to have had an impact on the likelihood of outbreaks, research suggests that facilities with more robust staffs have done better at containing the damage when COVID-19 does enter a building.

But workers have also been vulnerable to the virus. Nursing home staff held the dubious distinction of having the second-deadliest job in America in 2020, based on partial data analyzed by Scientific American — putting them behind fishers but ahead of loggers, pilots, roofers, and certain construction workers.

“Given that the CMS data for 2020 were only reported from last May onward, the full year’s actual death rate for nursing home staff may have approached or even exceeded that of fishers,” Scientific American observed.

The Altarum report comes during the same week that the workforce problem took center stage in Washington, where the Senate Finance Committee held a lengthy hearing on the coronavirus crisis in nursing homes.

“We’re extremely short-staffed,” Adelina Ramos, a certified nursing assistant (CNA) at the Greenville Center nursing home in Greenville, R.I., testified of her experience throughout the pandemic. “At one point, I was caring for 26 critically ill residents with only the help of one other CNA, a nurse and a housekeeper … I was horrified. We begged management for more staff on each shift, but they said they couldn’t find anyone.”

The American Health Care Association and LeadingAge, the two primary lobbying and trade groups representing nursing homes and assisted living facilities, made stiffer staffing requirements a key component of a reform proposal rolled out this week — though both organizations have also argued that beefing up the ranks of frontline caregivers will require higher reimbursements and more investment in workforce development programs.

Resident advocates and some researchers have cautioned that any additional funding for staffing should also come with transparency around nursing home ownership and management.