Nursing Home Staffing Shortage is a ‘Crisis on Top of a Crisis’

Skilled nursing workers are in the midst of a mass exodus from the profession, and not even unprecedented wage increases can compensate for the concerns of the 238,000 caregivers who have left the industry since the start of the COVID-19 pandemic.

The combination of workload, environment, culture and the physical and emotional strain exacerbated an already challenging staffing predicament operators were experiencing even pre-pandemic.

It’s what Harvard University professor David Grabowski calls a “crisis on top of a crisis.”

“We’ve overlooked and undervalued this workforce for a long time, and now we’re at a full blown crisis,” Grabowski said during a panel at AMDA – The Society for Post-Acute and Long-Term Care (PALTC) Medicine’s annual conference.

Nursing homes gained only 1,600 jobs in February compared to the 20,000 in the home health field and 15,000 for physician offices.

Meanwhile, skilled nursing occupancy rested at 76% in December, according to NIC MAP Data, released by NIC MAP Vision.

“Obviously we’ve seen lower census so we don’t have as many residents, but a number of individuals have left this workforce and unfortunately they’re not coming back,” Grabowski said.

He pointed to a recent study released in the JAMA Health Forum late last month that ultimately concluded increased pay was not enough to keep skilled nursing employment levels on pace with other health care sectors.

The research found that SNFs saw the second largest employment decline in Q2 2020 (8.4%), behind dentists (10%).

Contrast that with the fact that nursing home employees saw the largest wage increases of the sector in 2020 at 9.5% and 2021 at 6.3%, compared to 2019.

“We did try to pay our staff more, we need to pay them even more than we’re currently paying them … It’s not just about pay; pay is necessary but it’s not sufficient,” Grabowski said.

These conversations come just one week after the Biden administration unveiled its comprehensive proposed nursing home initiatives, ranging from staffing minimums to financial and operational transparency.

Thus far, the Centers for Medicare & Medicaid Services (CMS) has only set a definitive timeline for the minimum staffing standard – a measure that will be proposed within one year.

The 21 initiatives will have short-, mid- and long-term timelines for implementation, according to CMS Principal Deputy Administrator Jonathan Blum.

Emily Nicoli, chief nursing officer at UnitedHealthcare Retiree Solutions, said while pay is not everything, an employee friendly labor market is providing enticing alternatives to burned out health care staff.

“But in a time where someone can get a job at Chick-Fil-A and work during the days, no nights, limited weekends – they’re not open on Sundays to be fair – no holidays and make the same amount as a nurse without the body fluids. When you look at it that way, you can kind of see why we’re having such a problem here,” Nicoli said during the panel discussion.

The industry is “churning and burning” CNAs and nursing staff, pointing to a statistic that says 30% of nurses leave the profession in the first two years, she said.

Mary Knapp, director of health services at Foulkeways at Gwynedd in Pennsylvania, turned to Aretha Franklin’s 1960’s hit when determining what it might take to retain staff.

“Respect the nurses time, what they have to contribute and just them as a person,” she said.

Knapp also said the industry has an opportunity to recruit nursing leadership from disillusioned acute care professionals.

Nicoli echoed Knapp’s sentiments.

“Having someone that is interested in you, as a nurse when I say life changing – I genuinely mean that,” she said.