LTC Staffing Shortage Has Far-Reaching Implications

You’ve likely seen the “now hiring” signs in businesses of all kinds. The most recent data from the U.S. Bureau of Labor Statistics has the unemployment rate at just 3.6 percent for May 2022. While it is good news that so few people are out of work, there is a flip side to that coin that is hitting the senior living and care industry particularly hard.

According to results of surveys by the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) that were released recently, a large majority of long-term care facilities continue to face moderate to high staffing shortages and hiring challenges even as the pandemic begins to subside. Additionally, many of these communities are experiencing financial losses as well, the surveys found.

What impact might these staffing shortages and financial troubles have on the availability and quality of care seniors will be able to access both within senior living communities as well as in private residences?

Assisted living faces concerning staffing shortages

Assisted living communities offer a combination of housing, personal care services, and limited nursing care. Residents of an assisted living community typically need help with at least one of the six activities of daily living (ADLs) — bathing, dressing, eating, toileting, transferring, and continence. Additionally, they may require assistance with instrumental ADLs (IADLs) such as household chores. Assisted living services also may be delivered in a person’s private home.

The NCAL is the assisted living branch of the AHCA, representing over 4,000 assisted living communities within the U.S. The recent NCAL survey looked at 120 assisted living providers. Key findings from the survey paint a concerning picture for the industry.

52 percent of assisted living providers say their overall workforce situation has deteriorated since the beginning of 2022.
63 percent are experiencing staffing shortages with a quarter of those providers saying they have a high level of staffing shortages.
93 percent have increased wages to help attract and retain caregivers to their community.
98 percent have asked staff to work overtime or extra shifts due to the staffing shortages, and half have had to hire temporary agency staff to deal with this shortage.
87 percent say they have difficulty hiring new staff.
90 percent of assisted living providers say one of the biggest obstacles to hiring new staff is a lack of interested or qualified candidates.
48 percent of providers are concerned they may have to close their assisted living community if workforce challenges continue.
Assisted living providers say their operational costs have increased by an average of 40 percent since this time last year.
37 percent are currently operating at a loss, and 35 percent say they can’t sustain their current operating pace for more than one year.

>> View the full results of the NCAL assisted living survey.

Nursing homes also struggle to hire and retain adequate staff

Nursing homes, also called skilled nursing care facilities, offer their residents a higher level of medical care than do assisted living communities. Additionally, at a nursing home, care is provided 24/7 by the nursing staff. Nursing home residents typically need help with ADLs and IADLs as well.

Some residents of nursing homes have chronic illnesses or conditions, requiring them to remain in a skilled nursing setting for the long-term. Such residents receive not only medical care but also any needed rehabilitative services such as physical, occupational, respiratory, or speech therapy. Other nursing home residents are there for a short-term situation, for example, when care and/or rehabilitation is needed after a surgery or hospital stay.

The AHCA represents more than 14,000 nursing homes and other long-term care facilities across the U.S. Their recent survey of 759 nursing home providers had similarly concerning findings as the NCAL survey.

60 percent of nursing home providers say their workforce situation has worsened since January of this year.
87 percent are currently facing moderate to high staffing challenges. Of those, 48 percent are facing a high level of staffing shortages.
98 percent of nursing home providers are having difficulty hiring staff.
A staggering 99 percent are asking staff to work overtime or extra shifts, and over 70 percent have hired temporary agency staff to deal with staffing shortages.
The vast majority of nursing home providers have offered increased wages (95 percent) and/or bonuses (92 percent).
71 percent report that a lack of interested or qualified candidates is their top hiring obstacle.
61 percent are having to limit new resident admissions due to their facility’s staffing shortages.
73 percent of nursing home providers are concerned about having to close their facilities because of staffing challenges.
76 percent say their current financial situation/lack of funding is a hurdle to being able to offer competitive wages in order to hire adequate numbers of new staff.
Nursing home providers report that their costs have increased by an estimated average of 41 percent since last year, and 59 percent of providers report that they are operating at a loss.
53 percent say they can’t sustain their current operating pace for more than one year.

>> View the results of the AHCA nursing home survey.

A growing challenge for a growing industry

The root cause of the staffing shortages being experienced within the long-term care industry are multi-faceted. The pandemic has certainly been a contributing factor, but the industry also has challenges that predate COVID.

Many of the jobs within an assisted living or skilled nursing community are low-paying with long hours, physical and emotional demands, and sometimes unpleasant tasks. It is often work that is performed by low-skilled employees, who have found that, as a result of the low unemployment rate and rising wages, they can make the same or more money in other industries. (Of course those employees with more training or higher levels of education, such as RNs, do make more money, but the work is still demanding.)

Additionally, many people who have spent their careers working within the senior living industry have themselves reached retirement age. The numerous issues created by the pandemic within long-term care communities may have been the final straw for many employees, convincing those at or near retirement age that it was time to retire.

All of this has been compounded by the fact that the Baby Boomers are growing older and in some cases beginning to need long-term care services. So just as there are fewer employees there also are more prospective residents for these care communities. It indeed has the makings of a perfect storm within the senior living industry.

Broader repercussions of long-term care staffing shortages

You may be thinking, “I don’t need assisted living or skilled nursing care; this doesn’t impact me.” Hopefully you are right, and you never will need any type of long-term care services. The odds may not be in your favor, however.

According to the U.S. Department of Health and Human Services (DHHS)’s Administration on Aging (AOA), around 70 percent of people over the age of 65 will require long-term care services at some point. This means they will need help with at least two activities of daily living (ADLs) such as eating, dressing, or bathing — the type of care offered by assisted living communities. Some may even need the higher level of care provided by a nursing home.

“But even if I DO need care services, I’m going to remain in my own home and get whatever care I may need there,” you may retort. Make no mistake: This staffing shortage may still impact you in this scenario. In-home aides also are in scarcer supply and/or are increasingly expensive as individuals, staffing agencies, and long-term care providers all vie for the same pool of employees.

Our nation is on the precipice of a serious long-term care crisis. It is a complex issue with no simple solution. Our government, the private sector, senior advocates, and individual families must join forces to find viable solutions to address the care needs and preferences of our growing senior population. We also must find innovative ways to support the mental, physical, and financial health of all caregivers — paid and unpaid. Time is of the essence.

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