Executive Outlook 2022: Creativity and Flexibility are Key Amidst Worsening Staffing Crisis

Though some nursing home owners had hoped to put the COVID-19 pandemic behind them by the end of 2021, coronavirus variants and the exacerbated staffing shortages have made that impossible for most heading into 2022.

If this year has taught the sector anything, it’s that some threats to long-term care won’t be as temporary as many had hoped.

With 2021 in the rearview mirror, SNN reached out to some of the top executives across the sector – from juggernaut operators to therapy and financial partners to D.C.’s most powerful movers and shakers – for their predictions and expectations for the 12 months ahead.


Over the next few days, SNN will present visions of the future from those leaders, in their own words, in the hopes that looking to their insights may inspire a better future.

Mark Parkinson, President and CEO of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL)

​​COVID has proven to be anything but predictable. I like to think of myself as a calm optimist — it’s the way I strive to lead AHCA/NCAL. Unfortunately, we’re seeing some concerning trends with the omicron variant that indicate a reasonable chance that the United States will set new daily COVID-19 records in the coming weeks. It’s possible that COVID numbers will dramatically exceed what we saw last December. Since we know widespread cases in the community lead to significant risk for long term care providers, we need to be ready.

While this may sound disheartening, the vaccines provide hope, and there are steps providers can take. High vaccination rates and booster shots are key to protecting our residents and staff from the ongoing global pandemic, and providers have been at the forefront of getting everyone vaccinated. It’s time to double down on our efforts to increase the number of residents and staff fully vaccinated and boosted.


Workforce recruitment and retention is another critical issue we will face in 2022 and beyond. We have been calling for help for years, and now, we’re experiencing a full-blown crisis. We are in a crisis so dire that even the National Guard has had to step in to help care for residents in certain states. Our caregivers are emotionally and physically burned out. AHCA/NCAL continues to urge policymakers and public health officials to step up and provide resources to support our providers so they can recruit and retain the caregivers they need to keep serving their residents.

Additionally, as we move forward into the new year, we must recognize that the COVID-19 pandemic has exposed and exacerbated long-standing challenges impacting the long term care profession. The profession is dedicated to learning from this experience, renewing our commitment to our seniors, and offering solutions that will improve the quality of care in our nation’s nursing homes.

AHCA is advocating for meaningful reforms to protect seniors and prepare for a growing elderly population that deserves a robust, quality long term care system. We have prioritized four principles for nursing homes that will help prevent such devastation from happening again and strengthen nursing home care: clinical improvements, workforce, oversight reforms, and structural modernizations. We look forward to working with Congress in 2022 to make these proposals a reality.

Lori Porter, CEO, National Association of Health Care Assistants:

We all had high hopes for 2021 when the year began. However, while we made some steps forward, there were also many challenges. We overcame some, but others will continue to require our attention and energy in 2022.

One positive development was that certified nursing assistants (CNAs) took the spotlight in a very constructive way. After years of being ignored, dismissed, and taken for granted, 2021 was – in some ways – the year of the CNA. More than ever, national organizations, government officials, major universities, and others have reached out to the National Association of Health Care Assistants (NAHCA), eager to include the voice of the CNA in their programs, studies, reports, and publications.

COVID-19 vaccinations and vaccine hesitancy commanded intense attention in 2021. Our CNAs worked bravely and selflessly to care for their residents throughout the pandemic, putting themselves at greater personal risk. Many are now hesitant to get vaccinated for a variety of reasons, a primary one being lack of trust in officials and institutions that they believed have been unfair to and dishonest with them for years.

This summer, we received a Patient-Centered Outcomes Research Institute (PCORI) grant to conduct a study aimed at reducing high rates of vaccine hesitancy among direct care workers. This is one of two complementary studies PCORI approved for funding under an initiative to assess approaches for increasing COVID-19 vaccine confidence among long-term care staff.

Looking ahead to 2022, I believe that this trust will be essential in repairing the senior living staffing crisis. Leaders must make significant changes in how they hire, retain, train, and engage CNAs and other direct care professionals. They must endeavor to meet them where they are: take time to understand what CNAs have been through, learn how their compensation affects their lives, and listen to their concerns and advice about resident care.

Unemployment challenges in our sector are at an all-time high, and these issues will not dissipate over the coming months unless and until systemic and substantive changes are made. Paying CNAs at $15, $16, or in some cases even $17 per hour will no longer cut it in a world where Chick-fil-A is offering $18 to retain its workers. If 2021 was a time of reflection and contemplation about how to move forward in a “new normal,” 2022 should be about digging in to implement the changes that must be made to better serve residents and pay a living wage to people who work closest to those residents.

In NAHCA’s efforts to advance workforce solutions, we recently held a workshop to address staffing challenges head on. During the event, David Grabowski, PhD, suggested that there are two short-term solutions for the staffing crisis: getting residents and staff vaccinated and investing in the workforce. He proposed that by raising the pay of all the nation’s CNAs by $10,000 per year, or $5 an hour for a full-time worker, “this would have a total cost of $20 billion per year.”

This may sound like a huge sum, but, Grabowski said, “it’s less than one percent of the amount we’ve spent in six weeks to fight COVID.”

These solutions will not change just because the calendar turns to a new year. Early this year, we will launch a viable and significant part of the solution to the staffing crisis: the National Institute of CNA Excellence (NICE). NICE is a one-stop virtual career center for everything CNA related, including recruitment, certification, job placement, continuing education, and ongoing career support. We’re introducing NICE in Texas early this year and hope to recruit 5,0000 new CNAs well before the end of the year.

Providers need to create and sustain efforts that establish a range of paths for both career CNAs and those who want to move into other care roles.

Katie Smith Sloan, President and CEO, LeadingAge:

2021 has been a year of ups and downs for older adults and the aging services providers who serve them. We saw important and remarkable progress in the fight against the COVID-19 pandemic in the form of effective vaccines and boosters, allowing older adults and caregivers to emerge from the isolation that marked so much of 2020. Still, the emergence of omicron and other variants ensure, sadly, that COVID challenges will persist in the coming year.

With more attention to our sector comes a renewed possibility of a long-overdue reexamination of how our nation delivers, regulates and measures the quality of care in nursing homes. The current survey and certification process, designed for the 20th century, has not kept pace with current market needs. It is arcane and broken. We support current work by the National Academies of Sciences, Engineering and Medicine on Quality of Care in Nursing Homes, which focuses on a range of topics, from the connection between regulation and care outcomes to the efficacy of current payment models.

A critical piece of reform must address the chronic and worsening workforce struggles among nursing homes – and all across health care and aging services. Additional support is needed not only to fully reimburse providers for the cost of care and ensure workers are fairly compensated, but to also build our sector – to attract more prospects, develop career lattices and fill pipelines so that all of us who need care as we age can get it.

As we look ahead to 2021, LeadingAge is committed to working with members, partners, legislators and other stakeholders to preserve maximum choice for families and meet the needs of older adults—including those for whom nursing home care is the best option. The need for a range of quality care is growing ever more critical.

Talya Nevo-Hacohen, CIO, Sabra Health Care REIT:

One year ago, as we headed into 2021, we were optimistic about the skilled nursing industry and felt that we had nowhere to go but up. We were full of hope that the roll-out of the COVID-19 vaccines would allow us to return to “normal” quickly. As 2021 comes to a close, we wonder how long it will be before we feel like we are back on track while we wait to see the impact of the newest COVID-19 variant amid staffing challenges and, in some regions, postponement of elective surgeries.

It is clear that the industry’s occupancy and labor pressures that began in 2021 will persist into 2022 and the duration of these challenges will bend our industry to evolve.

Occupancy and revenue go hand in hand and drive the financial health of the industry. After witnessing the miracle of the vaccines in early 2021, occupancy began to rise and there was optimism that the worst was behind us. Those hopes dimmed as the emergence of the delta variant moved the finish line further away. Now we wait to see whether the latest variant will deal the industry another setback.

If occupancy and revenue do not begin to rise then the financial health of the industry is once again compromised.

Federal and state governments’ initial response to the pandemic was a laundry list of financial assistance, ensuring continued access to care for our most vulnerable citizens. The message was clear that skilled nursing was part of our country’s health care infrastructure. Today those funds are nearly all distributed and it is unclear how much additional financial support will be needed and whether any will be available.

Labor, both availability and cost, has been a weak link in the system and has now emerged as critical to skilled nursing’s recovery. The industry has lost 10% of its labor force; without staff, patients cannot be cared for.

For nearly two years, our front-line health care workers were soldiers on the battlefield fighting an invisible enemy. No wonder that they are exhausted, burnt out and leaving the industry. Our health care workers cannot be replaced by remote labor or automated; however, they can be paid a living wage and guided along a career path that is emotionally and financially rewarding.

Operators are already returning to focus on the basics of hiring, training and retention and adding flexibility and other benefits that will attract people to the industry and support their career path.

While we as an industry, a nation and citizens of the world are still battling the virus, it still feels like we are on the right path. We have won many battles over the past two years but there are still more to go before we conquer the unseen enemy and our own shortcomings.

Patti Cullen, President and CEO, Care Providers of Minnesota:

After living and breathing through and with a coronavirus that has now killed more than 800,000 people in this country, just two years after the first COVID-19 cluster was reported, it is a challenge both mentally and physically to move beyond the daily challenges. But to survive as a profession we do need to look beyond the daily counts of cases, deaths, vaccination rates and community spread and reflect on a future that is both reflective of lessons learned during this pandemic but also of external factors such as the role of technology, changing demographics, workforce powershift, and racial equity.

Starting with the lessons of the pandemic, we learned that the long-term care profession had a very tenuous base to start with — decades of financing challenges, workforce shortages, and infrastructure decay was further exacerbated by the unpredictable nature of the pandemic and the chronic stress endured by our workers and by the customers we serve. We learned that the social isolation imposed on the residents we serve for the “greater purpose” of infection prevention was so detrimental for our residents that we should never go back to that time again, yet the role of government to exercise additional authority on a worldwide basis to minimize the spread of such contagious viruses may indeed be part of our lives in the future. We learned that we have only begun to touch opportunities for technology and the role it could and should play in day-to-day operations, information exchange, and general communication internal and external to our settings.

From telemedicine expansion to phone apps that track health status, digital technologies will continue to transform health services. During the pandemic most medical offices converted to virtual sessions, which both providers and consumers adapted to and in many cases plan to continue to utilize. Each week new technologies are introduced for the general populations that could be adapted to specific uses for seniors — think about how Alexa alone could be an assistant to solo seniors or using Amazon echo to send announcements to seniors in congregate settings or “smart” watches that would be able to record critical medical information to be sent electronically to primary care clinics.

As the baby boomer generation continues to cycle through the various stages of long-term care service needs, the profession has been responding by building housing developments that are of interest to this demographic group, with a variety of living options that match the needs and wants of a growing and diverse population.

Gone from consideration for many are the aging nursing facilities built 50-70 years ago as seniors and their families gravitate whenever possible to new buildings with modern service options. These choices will continue to be a dichotomy between the “have and have nots” as many of these new choices are private pay only, with both the Medicare and Medicaid programs lagging behind in paying for both services and housing in non-institutional settings.

Fast forward, however, to 15 years from now. Older adults are projected to outnumber children under age 18 for the first time in U.S. history by 2034, according to Census Bureau projections. The workforce crisis experienced today will be exacerbated by the demographics alone—those needing services will be far greater in numbers than the workforce itself.

The wage competition isn’t the only challenge to overcome in an environment when unemployment continues to be low and job demand high. A variety of recruitment and retention options will be the norm from paying workers on each day of work rather than waiting until “pay day” to providing flexible scheduling to addressing day care and transportation roadblocks to paying for a multitude of career ladder options; to re-designing job functions in order to accommodate an older workforce.

Knowing the diversity of our workforce communities today and the demographic trend lines for greater diversity in our workforce is another employment trend that not only should be embraced but utilized as a recruitment tool. Organizations who consciously invest in equal treatment of employees, and make efficient use of the diversity of their work community will certainly gain a significant competitive advantage.

Erin Shvetzoff Hennessey, CEO, Health Dimensions Group:

Our profession started 2020 blissfully ignorant to the global pandemic lurking around the corner, we then ran joyfully into 2021 with the hope of the COVID-19 vaccine ending the pandemic that has been so unkind to those we serve, and we now enter 2022 battered and tired, but confident in our ability to adapt and survive, knowing our organizations’ missions will live long into the future.

2022 will bring with it hope and optimism if we can reflect on where we have been and use this ability to respond quickly to our new reality. This reality includes a mutating virus, a national workforce crisis, vaccine hesitancy and waning immunity, changing consumer confidence and preferences, and unrelenting regulatory scrutiny. These things are largely out of our control. We will respond aggressively and confidently to what we can control — delivering high-quality care and services, improving employee recruitment and retention, providing transparent communication to our care delivery partners, enriching the lives of those we serve and navigating our organizations into the future.

Each of us as senior care leaders will be challenged to look at this new reality and make critical decisions about redesigning our organizations and services to meet the needs of our seniors, both inside and outside our walls. With the redesign we will need to do in 2022, 2023 will perhaps find our organizations bigger or smaller, more diverse or more focused.

Most importantly, we will still be standing and ready for our future, one where we continue taking great care of the growing population of seniors who need our care.

It is my wish and prayer at this New Year that our organization and yours can find ways in 2022 to adapt to our new reality, and that this evolution brings ongoing quality improvement for our residents, financial and operational stability to our businesses, and thanksgiving to our teams each day.

Companies featured in this article:

, , , , , ,