State’s Workforce Funding Boost Yields Limited Results as Labor Pool Shrinks Due to Licensing, Training Issues

Many states have ramped up funding for nursing home staffing in recent years, and while the resulting increased wages and incentives have worked towards better retention, labor supply continues to be a problem. 

For example, Illinois passed legislation to support staffing at nursing homes, including through provision of more than $700 million in funds annually to Medicaid-funded facilities. However, advocates for nursing home residents say those efforts have not achieved their intended goal, a story in the Herald Bulletin states. 

“They’re looking at this in real time saying, ‘Well, there’s still staff challenges that are affecting my life,’” said Susan Real, CEO of the East Central Illinois Area Agency on Aging. “They conclude that there’s very little improvement.”


Illinois lawmakers passed a bill after the COVID pandemic pushed many nursing homes in the state to the brink, with Illinois housing nearly half of the 100 most understaffed facilities in the nation at the time, the article said.

The state allocated money to reward nursing homes for improving staffing levels and provided funds to raise wages for certified nursing assistants (CNAs) – about $360 million – if facilities met staffing targets.

The targets were based on the Centers for Medicare & Medicaid Services’ (CMS) criteria linked to Staff Time and Resource Intensity Verification, or STRIVE study. Incentive payments kicked in when a facility reached 70% of the threshold defined by STRIVE.


Moreover, another $85 million was approved to subsidize wage hikes for CNAs based on their years of experience, starting with a $1.50 per-hour boost for those with one year of experience and up to $6.50 per-hour increase for those with six or more years of experience, the article noted.

The bill also approved another $202 million in combined state and federal funds to raise the daily reimbursement rate by $7, with another $4 per day added for facilities serving a higher-than-average percentage of Medicaid patients.

These efforts did lead to gains in staffing at nursing homes, and Illinois saw an 11% increase in nursing home staffing ratios, surpassing improvements in other states, according to a review conducted in December by the Illinois Department of Healthcare and Family Services.

While in 2022, the number of facilities falling below the 70% STRIVE target stood at 154, that number fell to just 53 by the middle of 2023, the review found.

And so now, instead of having nearly half the nation’s most understaffed nursing homes, there are only 18 such facilities, Matt Hartman, president and CEO of the Illinois Health Care Association, which helped draft the law, said in the article.

That said, Illinois still ranks in the bottom 10 states with the worst senior-care staffing, according to Seniorly, an online resource for people seeking long-term care.

And that’s due to a short supply of new workers entering the labor pool.

Although more Medicaid funding is needed to cover the $500 million shortfall of funds between overall costs and state reimbursements, it’s also hard in Illinois to find workers and that needs to change, Hartman said.

A perennial issue seems to be understaffing at the state licensing agency, which means that it sometimes takes over a year to approve and issue licenses to professional nurses, causing many workers to move out of state or onto other jobs, Hartman said.

Moreover, many community colleges have cut back on their nursing programs due to state regulations, and it simply doesn’t pay to have a registered nurse (RN) teach courses to a much smaller pool of CNA students, the article notes. All this means a shrinking clinical labor force.

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