The US was experiencing nursing home staff shortages prior to the pandemic, however, during the course of the last two years, the U.S. Bureau of Labor Statistics has recently reported that 420,000 employees left long-term care facilities roles, further deepening the shortage crisis and impacting nursing homes on a critical level (Source: Washington Post, Jan 2022). Additionally, about 58 percent of the nation’s 14,000 nursing homes are limiting admissions, as seen in the voluntary survey conducted by the American Health Care Association, their representative body. (Source: Washington Post, Jan 2022)
As a result of significantly dipping staff levels, many hospitals across the country have been forced to delay discharge of patients returning to their care homes given the lack of staff support available when the patients would be returning home (Source: Fierce Healthcare, Jan 2022). What is certain, is that staff shortages are the most pressing, main concern within the sector, making the need to find a solution paramount given the domino effect that is now in place.
Care workers have frequently reported having to care for well beyond the number of patients or residents that should be overseen by just one member of staff. This is having an obvious negative impact on staff morale and wellbeing, in some cases pushing them to the ends of their abilities. Across the country, there is a common thread of growing frustration amongst care workers with how they are expected to cope under such conditions and equally how they are managing those in care.
"If there was a fall or something else bad happening, say there is a confused resident having a hard time that really needs one-on-one attention, and you're not able to give it to them to get them to calm down so that they can rest, that is frustrating. It's sad, and it makes you want to not go back to work," says one care worker (Source: Health News from NPR, Feb 2022).
Frontline workers in long term-care are feeling they are letting their patients down, says Susan Reinhard, executive director of AARP's Public Policy Institute. "If you have too many people to care for, you're going to feel moral distress like, 'I'm not doing my best. I can't do the best job I've been trained to do,'" says Reinhard. "That is really devastating personally, just day after day,” (Source: Health News from NPR, Feb 2022).
It's understandably a challenging occupation, with often low pay, especially for those providing daily care, like nursing aides and staff. Recruitment is difficult to fill the gaps of those who have now left the sector. “We would love to hire more nurses and nurse aides to support the increasing needs of our residents,” Mark Parkinson, president and CEO of the American Health Care Association, which represents more than 14,000 nursing homes and long-term care facilities, said in a statement. “However, we cannot meet additional staffing requirements when we can’t find people to fill the open positions, nor when we don’t have the resources to compete against other employers.” (Source: AARP, March 2022).
Additionally, the impact of staffing levels have had an even more significant effect it seems. COVID-19 deaths in long term care facilities have comprised around 23% of all COVID-19 deaths in the US and those have been attributed to inadequate conditions exacerbated by staffing shortages it has been stated (Source: KFF.org).
When speaking recently to NJ Long-Term Care Ombudsman Laurie Facciarossa Brewer, she offered her thoughts on what she saw first-hand of her local care staff enduring due to shortages:
“During the worst of the pandemic, direct care staff were either getting sick, were forced into quarantine or decided to leave the business altogether, for perfectly understandable reasons. This resulted in many thousands of nursing home residents being forced to live in horrible conditions. We received calls from residents who had not been fed, changed or moved out of their beds for 24 hours, or longer. Residents were confined to their rooms for days and weeks without a break. There wasn’t enough personal protection equipment available and the federal guidance relating to infection control was continually evolving as we learned more about the virus. The staff who remained, who worked through this nightmare of illness and death, are the unsung heroes of the COVID-19 crisis.”
As pressure mounts, many are wishing for a fast-tracked solution to the shortages as staff are suffering heavily with fatigue and burden, leaving politicians trying to promise much quickly. President Biden, ahead of his State of the Union speech this year, directed his intention by stating, “Establishing a minimum staffing level ensures that all nursing home residents are provided safe, quality care and that workers have the support they need to provide high-quality care,” the White House said in a press release. “Nursing homes will be held accountable if they fail to meet this standard.” (AARP, March 2022).
Biden announced a new directive to regulate nursing homes with a more concentrated focus. The goal is to ensure all facilities have enough staff and equally to fully support all nursing home staff. Additionally, at the same time, President Biden wants to publicize information about nursing home operations and finances in an effort to become more transparent and provide wider visibility. Biden stated these measures are vital given the volume of investors who are acquiring so many facilities.
“As Wall Street firms take over more nursing homes, quality in those homes has gone down and costs have gone up,” Biden stated. “That ends on my watch.”
“It is ... the most important set of changes proposed in nursing home care since the 1987 nursing home law,” said Toby Edelman, Center for Medicare Advocacy (Source: Nursing Home411 Podcast).
These same sentiments have been repeated amongst many across the industry. There were weaknesses in the long term healthcare system prior to the pandemic and those weaknesses were made very plain when the virus began. Now, with industry shortages in full view, they are getting a great deal more focus.
Previously, the Obama administration announced it would increase supervision of nursing homes with the implementation of stricter safety requirements, increased inspections and more overall training in the sector. However, Trump reversed many of those changes in his overall effort to decrease regulations affecting the healthcare industry.
President Biden is now seeking to reinstate those changes that Obama began during his administration. Those changes would require the gathering and publication of more information about exactly who owns and manages nursing homes and how they manage their finances which is obviously meeting with some friction.
Conversely, many see this as an unnecessary step by the Biden Administration, adding more complexity to an already fret situation. ‘Each facility has had to find work arounds in order to keep the day-to-day of tasks ticking over, that is the reality, and adding more changes to how our facilities are run will not be a good thing’ says Jeff Robinson, Director of Nursing with The Village of East Harbour when we spoke to him.
What remains to be seen is how all of the proposed standards will be rolled out. The industry is waiting to understand how the next stage of long-term care will be realized. It has been a time of learning, brought on by much suffering and agonizing through the course of the last two years. Many administrators are finding their own ways to cope and implementing solutions to shortages but constant revision is required to stay on top of schedules and retention of staff.
Quality of patient care is an ongoing concern and the pandemic highlighted the need for robust procedures to protect patients as well as staff. Care providers are still divided on how best to proceed to ensure that shortages like this never occur again. Some say higher wages would solve retention issues of care staff leaving. Others say more definition at a national level of the standard of care would be the solution. Perhaps it is a measure of both that will see the US long-term care sector find more stable ground after the extremes it has endured in recent years.
