Nursing Home Staffing Crisis: Ramifications for Healthcare

Ken Perez
Vice President of Healthcare Policy and Government Affairs

As a result of the so-called Great Resignation, the U.S. Bureau of Labor Statistics reports that healthcare lost 524,000 employees – about 4 percent of its workforce – between February 2020 and September 2021.

However, most people are unaware that the nursing home industry lost almost 235,000 workers—15 percent of its total workforce—during that time.

In May, the American Health Care Association (AHCA) surveyed 759 nursing homes and found that 60 percent reported staffing issues had worsened since January, while 87 percent reported having "moderate or severe" staffing issues.

So what are some of the causes of the shortage? Historically, nursing homes have been challenging to work in, with intense job demands and a lack of respect for their profession. Researchers from UCLA and Harvard Medical School discovered that nursing home turnover rates were 128 percent and 94 percent, respectively, in the U.S. during 2017-2018.

Over one-third of all COVID-19 deaths occurred in long-term care facilities, and more than a million nursing home employees have been infected during the pandemic. Consequently, many nursing home employees have moved on to work in hospitals, clinics, private home healthcare or have left the industry entirely.

According to the AHCA, most nursing homes have employed temp workers and limited admissions to manage shortages. Additionally, many asked current employees to work longer hours.

Sixty-seven percent of nursing homes said they might be unable to stay open if staff shortages persist. Operating costs at nursing homes have risen an average of 41 percent in the last year because of contract labor, overtime, and other factors. Fifty-nine percent of nursing homes are currently operating in the red. According to a long-term care industry consultancy, as much as 40 percent of the nursing home population may be housed in facilities that could shut down this year.

Staff shortages in nursing homes have led to deteriorating health conditions for residents. To date, an estimated 170,000 COVID-19 nursing home deaths have occurred during the pandemic.

The nursing home labor shortage can also affect health systems. Hospitals rely on nursing homes to send patients following treatment. If there are no nursing homes, patients stay in the hospital for prolonged periods, which keeps beds occupied, reduces access to care for other patients, and drives up hospital costs for labor and supplies.

On a rolling 12-month time frame, more than 19 percent of post-acute discharges during the fourth quarter of 2020 were to nursing homes, according to Trella Health's research. Still, referrals from skilled nursing facilities grew 10 percent between 2019 and 2021. More than one-third of the members of LeadingAge, a national association of nonprofit senior care provider organizations, are unable to accept new residents owing to staff shortages, according to a late-2020 poll.

The traffic jam at nursing homes has adversely impacted hospitals. "Ready to go and no place to go" is a phrase frequently used in the medical industry. The result can be a high volume of patients who are eager to be discharged. Roxborough Memorial Hospital, a 131-bed community hospital in Philadelphia, reports that it sees three times as many patients stuck in its emergency department.

More than 200 patients were waiting to be discharged from Brigham and Women's Hospital in Boston in early January. According to the Massachusetts Senior Care Association, nursing home admissions have been restricted because of staff shortages at more than 60 percent of facilities in the state.

In addition, a recent study by researchers at Vanderbilt University Medical Center found that hospitals in communities with greater post-discharge access to nursing homes experienced lower hospital readmission rates. The study, which used national hospital-level data, concluded that for Medicare patients who were hospitalized for acute myocardial infarction, heart failure, or pneumonia, hospital readmission rates were negatively associated with per-capita supply of licensed nursing home beds.

Thus, it’s clear that the nursing home staffing crisis is closely related to hospital operations, reflecting the continuum of care's interconnectedness. Nursing home labor challenges are prevalent throughout the healthcare industry, so mandating national staffing standards would simply transfer money from one area to another. The need for more creative, strategic ideas, including greater labor-saving and productivity-increasing technologies, cannot be overstated.

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Disclaimer
The views and opinions expressed in this blog are those of the authors. They do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. Assumptions made in the analysis do not reflect the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.