Lawmakers Highlight Health Care’s Workforce Shortages, But Long-Term Care Garners Little Attention

Long-term care facilities were mentioned only briefly during a U.S. Senate hearing on Thursday concerning health care workforce shortages, before leadership turned to broader issues of primary care physician scarcity and how rural and ethnic shortages in the sector will be exacerbated by the pandemic.

Early in the conversation, Sen. Susan Collins of Maine, a Republican, did tie Medicaid reimbursement to low wages in nursing homes. She also acknowledged a need to train more geriatric health professionals to meet a growing aging population.

“At a time when our nation is aging and more and more people are living longer with increasing health needs, these shortages have serious consequences,” said Collins, who has previously backed multiple pieces of legislation supportive of home health providers. “There are more than a quarter of a million Mainers who are over the age of 65, and we only have 40 geriatricians.”


Aging services advocates were grateful for the attention, even if it was a brief spotlight placed on long-term care.

“We thank Sen. Collins for bringing attention to the particular shortage of workers within the nursing home sector and how low Medicaid reimbursement rates hamper our ability to compete for medical professionals and caregivers,” Mark Parkinson, president and chief executive of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), said in a statement following the committee hearing.

“We are also encouraged that members of the committee recognize the need for an increased focus on geriatric medicine, given the rapid growth of our elderly population,” Parkinson added.


The AHCA/NCAL president said approximately 19,500 nursing home and residential care jobs were lost during the pandemic, according to the latest labor report, which he says is a continued and “startling decline.”

The solution, or at least the start of one, lies with incentives to produce more geriatricians. Examples include the Geriatrics Workforce Enhancement Program and partial forgiveness of medical school debts, Collins said.

There are currently 48 such programs in 35 states.

Dr. James Herbert, president of the University of New England and one of four panelists during the Senate hearing, added that interprofessional education will help with continuum of care for the aging population, a definitive shift from a more traditional, siloed health care education system.

“Diseases of aging often encompass a broad scope of conditions, heart disease and diabetes treated by primary care practitioners, isolation by social workers, oral health by dentists and hygienists and so on,” explained Herbert. “At UNE we’re weaving geriatric training throughout all of our health care professionals. So rather than just merely training more geriatricians, we’re weaving training in geriatrics and in behavioral health across all of our health care professionals in this team-based approach.”

This kind of health care cross-training has been shown to decrease physician burnout and reduce medical errors in the field, Herbert said.

Senators and panelists also noted that qualified nursing applicants, including those that go into the skilled nursing facility subset, are turned away from educational programs simply because there aren’t enough faculty to go around.

In 2019, about 80,000 nursing applicants were turned away from such programs because of faculty shortages, Collins said.

Dr. Herbert said UNE, among other universities, has started to train its own nurse educators to help with this bottleneck.

“I would say all of the faculty disciplines it’s a challenge (to find staff), but nursing in particular,” Herbert said. “A big challenge is that nurses can simply make more out in practice than we can pay them at universities.”

The college president added that higher staff salaries could mean higher tuition or less financial aid, institutional aid UNE offers its students.

Senators and panelists mentioned Title VII and VIII programs multiple times as a way to address nursing shortages — the programs provide funding for health professions training and nursing workforce development, respectively, by reducing student debt when doctors or nurses start their careers.

Panelist Dr. David Skorton, president and chief executive of the Association of American Medical Colleges, said the organization supports the government’s $1.5 billion investment in the Title VII and VIII programs.