Nursing homes have a long-term care problem: 18 months after the Covid-19 crisis began, their staffs are still shrinking.
While employment in nearly every occupation has been recovering from the shock of the pandemic, the number of people working in nursing homes and other long-term-care facilities has continued to drop, according to federal data.
Nursing homes and residential-care facilities employed three million people in July, down 380,000 workers from February 2020, according to the Bureau of Labor Statistics. Industry employment has fallen every month except one since the World Health Organization declared Covid-19 a global pandemic in March 2020. By contrast, job losses in the leisure and hospitality industry, another hard-hit sector, began reversing in May last year, and the industry has recovered almost 80% of the jobs that were lost in the first months of the pandemic.
“I’ve been in the industry for 40 years and I’ve never seen it this bad,” said Terry Robertson, chief executive of Josephine Caring Community, a long-term-care facility in Stanwood, Wash.
Turnover has been twice as high as it was before the pandemic, he said. “We turned down 138 admissions from hospitals last month because we didn’t have the staff to open another unit,” he said.
Nursing-home staff have quit—and stayed away—because of the pay, burnout and fear of Covid-19, administrators and workers say. Enhanced unemployment benefits and competing job opportunities also have played a role, they say.
Sheena Bumpas, a nursing assistant in a dementia unit at a long-term-care facility in Duncan, Okla., said staffing shortages create a cycle that wears down workers who enter or remain in the field.
“When you’re short on people, you have to work extra because someone has to be there to take care of the residents. You work and you work and after a while you just get burned out,” said Ms. Bumpas, who has been in her job for 19 years and is the vice chair of the National Association of Health Care Assistants, a nonprofit professional association.
Industry experts worry worker shortfalls will lead to a deterioration in care.
“We see staffing shortages as a safety hazard and a quality problem,” said Ari Houser, a statistician who manages the AARP Public Policy Institute’s nursing-home data dashboard.
Research shows that when homes are understaffed, the care of residents can suffer as they wait longer to be fed, brought to bathrooms or receive responses to their calls for assistance. A study last year found that facilities with higher levels of nursing staff tended to have fewer Covid-19 outbreaks and related deaths.
The scarcity of workers is a long-term predicament for the industry. Dissatisfaction with wages, combined with the fact that certified nursing assistants typically receive little training and therefore develop few specific skills tying them to the field, mean workers frequently switch jobs or leave the industry altogether for roles that pay slightly more or offer better hours or benefits. Median pay for nursing assistants was $14.82 per hour in 2020, according to the Bureau of Labor Statistics.
Thousands of nurses and aides got sick over the past 18 months and many reported being fearful of bringing the virus home to their families, according to federal data and academic research. Those who remained on the job coped with heavier workloads, new protocols related to personal protective equipment and distraught families and residents who were separated during Covid-19 lockdowns.
While the healthcare sector as a whole is facing acute shortages of nurses and other workers, the industry has recovered more than half of the employment it lost in the spring of 2020.
Hospitals and other facilities also pay better than nursing homes and can attract nurses and aides with the promise of higher wages, better benefits and career opportunities, administrators and experts say.
Most nursing homes have few levers to pull to raise pay or improve the appeal of the job, said David Grabowski, a professor of healthcare policy at Harvard Medical School. Some 80% to 85% of their revenue comes from Medicaid and Medicare, so their income is largely dependent on reimbursement rates set by those programs, Mr. Grabowksi said. Medicare typically covers limited-period stays for beneficiaries, while Medicaid is the source of funding for many long-term residents. Hospitals, by contrast, receive a large share of their revenue from commercial insurance, Mr. Grabowski said.
At Josephine Caring Community, Mr. Robertson is offering signing bonuses of up to $7,000 to nurses and $3,000 to nursing assistants, along with bonuses for current employees who refer new hires, and has bumped up hourly pay for all positions. It can afford to offer incentives and raise pay because the nonprofit paid off its mortgage and has investments that are making money, he said. But Medicaid reimbursement rates limit the facility’s ability to compete for workers and therefore to make beds available for patients who need residential care, he added.
Barbara Aldaz, the facility’s staffing coordinator, works a second shift as a nursing assistant once or twice a week, or comes in on weekends to fill in or plan schedules for the following days. “Basically I’m working seven days a week,” she said, adding that this pace has been the new normal since late spring.
Covid-19 vaccines have brought relief inside nursing homes as resident and staff infections have declined. But they have also created another staffing challenge for administrators concerned that workers will walk away if they are required to get the shot. About 61% of staff at long-term-care facilities are vaccinated, and 83% of residents, according to government data. Covid-19 cases are now on the rise again, led by infections among staff members, according to federal data.
President Biden last week said his administration would require nursing homes to vaccinate their staff against Covid-19 or risk losing Medicare and Medicaid funding.
The threat essentially obligates nursing homes to comply since so much of their funding comes from those two programs, but it will “cause a sizable exit of [certified nursing assistants], which will worsen the shortage,” said Lori Porter, co-founder and chief executive of the National Association of Health Care Assistants. “The fear is real, the outcome is unknown, but until everyone—vendors, families and visitors—are vaccinated,” Ms. Porter said, “nursing home residents will not truly be protected.”