By now, anyone involved in healthcare workforce solutions is painfully aware of the ongoing nursing shortage. It’s a nationwide healthcare crisis, where nurses are striking due to staffing shortages and yet nursing schools are turning away thousands of qualified applicants, as we discussed in depth this October. What’s less often talked about is the crisis affecting long term care (LTC) facilities and nursing homes, which are confronting a severe staffing shortage. This shortage has been steadily worsening in recent years and reached critical levels during the COVID-19 pandemic. The consequences are far-reaching, impacting both the quality of care for residents and the financial viability of these essential facilities. Despite many health systems attempting to move away from staffing providers, workforce solutions agencies may be the best hope for overcoming the challenges.

Understanding the Causes of LTC Staffing Shortages

To fully grasp the shortages of essential staff in nursing homes and long term care facilities, it’s important to examine the leading factors contributing to them. 

Aging Population and Increased Demand

The aging demographic in many developed countries has led to a surge in demand for healthcare services, including those provided by nursing homes. As the population ages, the need for specialized care and attention increases, putting significant pressure on existing nursing home staff.

High Turnover Rates

Nursing homes often experience high turnover rates among their staff. Long hours, physically demanding work, and emotional stress contribute to burnout and dissatisfaction among healthcare professionals. As a result, recruiting and retaining skilled personnel becomes an ongoing struggle.

Insufficient Training Programs

The healthcare industry requires specialized skills, and the shortage is exacerbated by a lack of comprehensive training programs. This makes it challenging to fill vacant positions with adequately qualified individuals, further worsening the staffing crisis.

Challenges for Certified Nurse Assistants 

Certified Nurse Assistants (CNAs) are in many regards the lifeblood of quality care in LTCs. CNAs are the trained professionals providing the most direct patient care in long term care facilities. They are often responsible for feeding, bathing, talking to, sitting with, and caring for other people’s loved ones. However essential, they are also the group of healthcare workers most embattled, which is a significant problem for maintaining a continuum of care in the country’s LTCs and nursing homes.

• Low wages and inadequate benefits: The median hourly wage for a nursing assistant (CNA) is only $15.54 to $17.56, significantly lower than the national average for all occupations. This makes it difficult for nursing homes to attract and retain qualified workers. Additionally, many CNAs lack access to affordable health insurance and paid sick leave.
• Demanding work environment: Nursing homes are often understaffed, which leads to long hours, high stress, and limited opportunities for advancement. Many workers feel burned out and undervalued.
• Aging workforce: The average age of a CNA is 48, and many are nearing retirement age. This means that the industry is facing a wave of retirements without enough young people entering the workforce to replace them.
• COVID-19 pandemic: The pandemic exacerbated the staffing shortage in several ways. Many CNAs left the workforce due to health concerns or childcare issues. Additionally, COVID-19 restrictions made it difficult for nursing homes to recruit and train new staff — a problem that persists, remains imperative, and requires immediate attention.

The low pay rate is perhaps one of the biggest barriers for both CNAs and the LTCs that need them. Compare that wage to other industries, where the work is substantially less demanding and involves little to no special training or certifications, and the issue becomes apparent.

• The median hourly wage for fast food workers ranges between $14.00 and $17.00 per hour.
• A cashier at a grocery store generally brings home $15.00 to $18.00 per hour.
• Hotel clerks also earn about $15.00 to $18.00 per hour.
• And many positions in retail and hospitality, while nearly equivalent in pay to CNAs but without specialized training or the same levels of stress, also allow employees to collect tips. Bartenders, servers, Starbucks staff, and some hotel workers all receive tips that augment their salaries. CNAs aren’t afforded this additional luxury.

There’s also the glaring income disparity between CNAs and executives at LTCs. Compared to what a nursing home administrator earns, CNAs take in roughly 109% less. A director’s salary is about 99.5% higher than a CNAs. Short staffing facilities in the name of maintaining profitability, when the income gap between talent and leadership is so stark, has been a driving force in the nursing strikes we witnessed over the course of 2023. But profits at all costs certainly don’t ensure the care that patients deserve. Because if a CNA can earn the same amount of money ringing up burgers, while forgoing the stress and hazards of healthcare, why would they stay?

Turnover rates for CNAs, LPNs, and RNs have increased dramatically. “The rate for CNAs was 54.8% in 2022, compared to 51.4% a year earlier,” Danielle Brown explained in her article for McKnights Long-Term Care News. “LPNs and RNs had lower turnover rates than CNAs, but experienced greater increases. LPN turnover jumped to 41.3% from 37.7%, while RN turnover was 46.2%, up from 41.1%. The national turnover rate for all nursing home employees was an eye-popping 48.5%, up significantly from 39% in 2021. That’s a more than 25% net rise.”

Problems Associated with Staffing Shortages in Nursing Homes

The staffing shortage has a significant negative impact on nursing homes and their residents.

• Compromised Patient Care: Insufficient staffing levels compromise the quality of care provided to residents in nursing homes. Overworked staff may struggle to meet the individual needs of residents, leading to a decline in overall patient satisfaction and well-being.
• Increased Stress on Existing Staff: With fewer personnel available to handle the workload, existing staff members are forced to take on additional responsibilities. This increased workload can result in burnout, decreased morale, and negatively impact the workplace environment.
• Compliance and Regulatory Concerns: Adequate staffing is not only essential for providing quality care but also for ensuring compliance with regulatory standards. Nursing homes face penalties and legal repercussions if they fail to meet staffing requirements outlined by healthcare authorities.
• Increased Resident Dissatisfaction: Residents and families are understandably frustrated when staffing shortages lead to inadequate care. This can damage the reputation of nursing homes and make it difficult to attract new residents.

Potential Solutions

The White House has become involved in the LTC staffing crisis, but the proposal it released has received criticism from both political parties. “The proposal is dividing Democrats, especially some front-line members facing a difficult reelection in 2024,” Nathaniel Weixel reported in The Hill. “Those lawmakers, mostly from rural areas, argue that the proposal is too strict and would force nursing homes to close.”

Weixel went on to note that “the lawmakers said the rule would result in ‘limited access to care for seniors, mandatory increases in state Medicaid budgets, and could most consequentially lead to widespread nursing home closures.’” 

Almost 95% of LTCs don’t meet at least one of the proposal’s three staffing requirements. The Centers for Medicare and Medicaid Services (CMS) said it will invest $75 million in boosting workforce recruitment and training, but David Grabowski, a professor of health policy at Harvard Medical School, “said that likely won’t be nearly enough to overcome the existing shortages,” as Weixel wrote.

Conversely, consumer and nursing home advocates, including unions, want the administration to strengthen the requirements. But the challenge of meeting mandated minimums remains with no clear direction on how LTCs should achieve them. And although the proposal is federal, enforcement and interpretation of “sufficient staffing” is left for individual states to decide. Another problem is that Medicaid reimbursement rates are too low. 

“Grabowski said he would like to see more political will behind giving nursing homes more money to meet the requirements,” Weixel pointed out.

There is no easy answer to the staffing shortage in nursing homes, particularly given the divisive nature of the White House proposal, but several solutions can be implemented by business leaders in the industry.

• Increase Wages and Benefits: Making nursing homes more competitive in terms of compensation will attract and retain talent. This includes offering higher wages, affordable healthcare, paid sick leave, and opportunities for advancement.
• Improve Working Conditions: Nursing homes need to invest in their staff by providing training and development opportunities, creating a positive work environment, and promoting work-life balance.
• Invest in Technology: Technology can help to improve efficiency and reduce the workload for CNAs. Examples include telehealth, medication management systems, and electronic health records.
• Expand Recruitment Efforts: Nursing homes need to develop creative and targeted recruitment strategies to reach potential candidates, such as partnering with community colleges and vocational schools.
• Advocate for Policy Changes: Government funding and policy changes are needed to support the long-term sustainability of nursing homes and the workforce. This could include increased Medicaid reimbursement rates and investments in education and training programs for CNAs.

LTCs and Nursing Homes Should Increase Reliance on Staffing Providers

The healthcare industry as a whole has recently made strides in bringing recruitment inhouse, but staffing providers remain vital in surmounting the obstacles the industry faces right now.

Specialized Recruitment Strategies

Staffing agencies specializing in healthcare recruitment bring a wealth of experience and industry knowledge to the table. By understanding the unique demands of nursing homes and long-term care facilities, these agencies can develop targeted recruitment strategies to identify and attract qualified professionals.

Rapid Response to Vacancies

Staffing agencies can provide a rapid response to sudden vacancies, ensuring that nursing homes and long-term care facilities are not left understaffed. This agility is crucial for maintaining continuity of care and preventing disruptions in service delivery.

Access to a Diverse Pool of Candidates

Leveraging their extensive networks, staffing agencies can provide nursing homes with access to a diverse pool of candidates. This is particularly beneficial in addressing the specific needs of each facility, including specialized skills in geriatric care.

Flexibility in Staffing Solutions

Staffing agencies offer flexible staffing solutions to nursing homes, including temporary placements, part-time positions, and full-time roles. This flexibility allows healthcare facilities to tailor their staffing approach based on fluctuating demand and operational requirements.

Comprehensive Training and Development Programs

Recognizing the need for skilled professionals in the healthcare sector, staffing agencies often invest in comprehensive training and development programs. This ensures that the professionals they place in nursing homes are not only qualified but also equipped with the latest knowledge and skills required for the job.

Staffing providers can collaborate with training institutions to develop tailored CNA training programs that align with the specific needs and standards of the healthcare facilities your agency serves. This ensures that CNAs are equipped with the skills and knowledge required for the roles they will be placed in.

They can also support ongoing professional development initiatives for CNAs, even after they have completed their initial training. This could involve offering advanced training programs, workshops, or certifications to enhance their skills and keep them updated with industry best practices.

Mitigating Burnout and Enhancing Morale

By providing temporary or part-time staff to alleviate the workload on existing employees, staffing agencies can play a key role in mitigating burnout and enhancing overall morale within nursing homes. This support contributes to a healthier work environment and improved job satisfaction among staff.

Cost-Effective Solutions

Staffing agencies can offer cost-effective solutions for nursing homes facing budget constraints. By providing temporary or part-time staff as needed, these agencies help facilities manage their staffing costs without compromising on the quality of care. 

Benefits

Many nursing homes don’t offer comprehensive benefits packages, including affordable healthcare and paid sick leave. This lack of support makes the job less attractive to potential employees. Staffing providers, on the other hand, almost always have competitive benefits programs in place that include medical, dental, vision, disability, and 401(k). At Oloop, for example, all healthcare professionals receive these benefits, with dental and vision coming at no out-of-pocket costs to the worker. 

Staffing Providers Exist to Overcome Staffing Shortages

The staffing shortages in nursing homes and LTCs are a complex challenge that demands innovative solutions. Staffing companies, with their expertise in healthcare recruitment, offer a ray of hope for nursing homes grappling with this crisis. By addressing the root causes, providing flexible staffing solutions, and investing in training and development, staffing firms play a crucial role in ensuring that nursing homes can continue to provide high-quality care to our aging population. As the healthcare landscape evolves, collaboration between nursing homes and staffing companies becomes increasingly vital for the well-being of both patients and healthcare professionals alike.

Photo by National Cancer Institute on Unsplash