Aging Population Drives Demand for Long-Term Care Amid Severe Staffing Shortages and Low Pay

Despite the increasing need for long-term care due to an aging population, providers are facing significant challenges in recruiting and retaining workers – many of whom cite long hours and low pay as the reason for leaving the profession.

“My paycheck, you know, was literally just nothing,” Culix Wibonele, a CNA, told CNHI News. “I was kind of shocked, like, the amount of work we (were) expected to do and the pay you get at the end.”

By 2030, approximately 20% of the U.S. population will be 65 or older. However, staffing shortages remain a critical issue, with many facilities experiencing understaffing in the wake of the finalization of the staffing mandate.


Alice Bonner, director of strategic partnerships for the Center for Innovative Care in Aging at Brown University, told CNHI News that some of the facilities she works with see complete turnover on a yearly basis.

“The people who are left are working much harder, double shifts, overtime and working with agency and temporary workers,” she said.

The COVID-19 pandemic exacerbated existing labor shortages, and the workforce has not fully recovered. A March survey by the American Health Care Association found that nearly all nursing homes have open positions and face recruitment challenges.


In a recent Skilled Nursing News webinar, industry leaders said that while the staffing mandate aims to improve patient care, it fails to address the current staffing shortages, regional variations, and fixed reimbursement rates that make compliance difficult.

“Where are we going to find these nurses?” Meagan English, chief people officer at Marquis Companies, said during a recent panel interview with Skilled Nursing News. “We’re already looking for them and we can’t find them. Then there’s the funding element. [We don’t have a system] where you can negotiate your reimbursement rate and raise your rates when your expenses increase, we don’t have that capability in our sector. We have a fixed reimbursement, and we haven’t thought through those plans.”

English proposed focusing on individualized facility assessments, immigration reform and increased capacity in nursing schools to address the staffing supply issue.

“There aren’t registered nurses sitting around waiting for jobs right now, especially not in our field. It’s not for lack of trying; it’s for lack of supply,” she said. “How are we going to solve that problem? It involves capacity in nursing schools and immigration law reform. If we’re asked to increase wages, who can compete with hospital systems? If we’re asked to drastically increase commercial spending on labor, then what is the funding mechanism for that? We need to come back to the table and figure out a feasible plan to overcome these obstacles before implementation. There are risks of non-compliance that could affect many communities.”

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