Federal data shows that staffing levels dropped 7.8% since the first quarter of 2021, and both Illinois and Missouri fell below 3 nursing staff hours per resident day.
That’s according to a report from the Long-Term Care Community Coalition (LTCCC) using data from the Centers for Medicare & Medicaid Services provided by nursing homes.
National staffing averages for Q3 2021 were 3.63 total nurse staff hours per resident day (HPRD) and 0.63 for registered nurse (RN) staff (HPRD). That falls short of what LTCCC says is the amount of time needed to ensure that residents receive quality clinical care – 4.10 hours total care staff HPRD and 0.75 RN HPRD – according to previous studies.
This data reflects a pressing issue in the industry, as the Biden administration will look to address staffing minimums in its new reform package.
“I think we recognize that having three hours of nursing staff time per resident per day is extremely dangerous,” Richard Mollot, executive director of the LTCCC, said. “I think what we’re seeing is that the resident census has gone up, and I know the industry is happy about that but staffing isn’t keeping the same pace and that’s really problematic from a safety perspective.”
Average total resident census rebounded to 1.13 million, up 2.5% from the previous quarter and 5.5% since Q1 2021, according to the report, while staffing numbers dropped nationwide.
Some operators have accused staffing agencies of further exacerbating the staffing crisis by price gouging, charging exorbitant prices for contract labor and leading some operators to start their own in-house temp pools. But as Mollot said, while the data shows a significant increase in contract labor, it remains a small percentage of the sector’s overall staff.
Contract staff accounted for 7.1% of all nursing staff hours in the third quarter and that’s an increase from 5% in the first quarter.
Some states struggle more than others
At 2.98 nurse staff HPRD, Illinois nursing homes ranked last in the country, according to the report. The bottom five states were: Illinois, Missouri (2.99), Texas (3.3), Virginia (3.32) and Georgia (3.38).
On the plus side, the top five states for nurse staff HPRD were: Alaska (5.61), Oregon (4.72), Hawaii (4.48), North Dakota (4.45) and Maine (4.3).
Angela Schnept, LeadingAge Illinois executive vice president, said the state has traditionally struggled in recruitment and recruitment of certified nursing assistants (CNAs), in both its urban and rural areas alike for some time.
One problem she sees is that nurses can leave Illinois and work in another state with their Illinois license, but the same is not reciprocated if nurses from other states come to Illinois.
“Illinois is one of the only states out of all the Midwest, and all the states surrounding us, where we do not allow other RNs to come into our state and work under their existing state’s license,” she said. “They have to go through the whole licensure process again, which makes it an additional challenge.”
Another problem is that the state hasn’t put enough emphasis on career advancement and establishing “career ladders” for young people and CNAs entering the workforce.
While the state’s registered nurse staff HPRD ranked much more favorably – 0.68 compared to the national average of 0.63 — it has dropped 9.3% nationally since Q1 2021.
“These issues are longstanding and have been exacerbated a bit by the pandemic, but there is a tremendous amount of turnover and I think that the heart of the problem is not being able to retain staff,” Mollot said.
Schnepf said that LeadingAge’s members are “shaking the trees” to come up with anything to find successful new ways to recruit and retain staff.
“A number of our members started developing their own CNA school where they can recruit students from high school to learn what it is like to be a CNA,” she said.
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