Nursing homes are currently grappling with a historic labor crisis. Over the course of the pandemic, nursing homes lost more than 200,000 caregivers, or about 15 percent of the workforce. This job loss is worse than the losses incurred by any other health care sector, and, at the current pace, it is not expected to rebound until 2027. Workforce challenges in long term care existed prior to the outbreak of COVID-19, and the pandemic exacerbated them into a full-blown crisis. Caregivers are burned out after fighting the virus for more than two years, and nursing homes lack the resources to compete for workers due to chronic government underfunding.

As a result of these labor shortages, more than half of nursing homes are limiting new admissions, and nearly two-thirds are concerned their facility may have to close due to the staffing crisis. More than 450 nursing homes have closed over the course of the pandemic—many due to staffing shortages—and hundreds more may soon close.

The domino effect on seniors, their families, and our entire health care system is troubling. Seniors wait for days or weeks in hospitals for a space at a facility, and families are having to travel farther to visit their loved ones in long term care. Many hospitals are overwhelmed with patients who are ready to be discharged to receive post-acute care, but nearby skilled nursing centers cannot admit them.

The Challenges of a Staffing Minimum

Nursing homes would love to hire more nurses and nurse aides but are currently grappling with a historic labor crisis, and the workers are not there. Increasing staffing requirements at a time when facilities can’t find the people to fill open positions is poor public policy. Nearly every nursing home in the country is having trouble hiring staff due to a lack of interested or qualified candidates. Providers have dedicated numerous resources to recruiting and retaining caregivers, including increasing wages and offering bonuses. But nursing homes still struggle to compete with hospitals, other health care providers, and private businesses for qualified workers. Chronic underfunding by Medicaid causes current soaring labor costs to be unsustainable. Complying with an unfunded federal staffing mandate would be impossible under current conditions.

Increasing staffing minimums will make it harder for seniors to find the long term care they need. Ultimately, setting minimum staffing ratios without corresponding resources will further limit access to care for seniors. Nursing homes will have to continue to reduce the number of patients they can serve in order to meet ratio requirements, or close entirely. Hundreds of thousands of residents could be at risk for displacement as facilities would be forced to reduce their census to meet staffing ratios or close entirely.

Advocating for Solutions

A federal staffing mandate requires a significant, ongoing investment in our front-line caregivers. An analysis found that staffing minimums would require billions of dollars to hire nearly 200,000 additional nurses and nurse aides. These proposals need to be fully funded, and with proper resources, nursing homes can offer front-line caregivers more competitive wages and benefits.

However, the long term care industry also needs a comprehensive approach to recruit and retain long term caregivers. An enforcement approach will simply not solve this long term care labor crisis. Meaningful solutions that address the root causes of these chronic staffing challenges are needed.

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) encourages long term care professionals to advocate for direct aid and policies that will help us build a pipeline of dedicated caregivers. AHCA’s Care for Our Seniors Act includes thoughtful workforce policies that will help address nationwide nursing shortages, attract more caregivers to the profession, and support care professionals in developing a career in long term care. It includes proposals such as loan forgiveness, tax credits, affordable housing, child care assistance, and immigration reform.

Additionally, there needs to be a comprehensive approach to staffing beyond numbers. Every resident and nursing home is different, and a one-size-fits-all approach is not the solution. Nursing homes need to be able to assess the appropriate staffing levels based on their number of residents and specific needs.

Moreover, providers must advocate for policies that invest in full-time, dedicated caregivers, not just increase the use of costly agency or temporary staff in order to fill quotas.

Building a Pipeline of Caregivers

One proposal supporting a more comprehensive approach and our caregivers is the Building America’s Health Care Workforce Act (H.R. 468). This bill provides an extension in the time allowed for temporary nurse aides (TNAs) to become certified nurse assistants (CNAs).

During the pandemic, the 1135 waiver on training and certification of nurse aides allowed vital support to critical staffing needs for care of residents in nursing homes. Hundreds of thousands of individuals answered the call to serve our seniors in their hour of need and supported them with nonclinical tasks, such as helping with activities of daily living; delivering meals; assisting with dining, ambulation, and range of motion; and offering companionship to help residents stay connected and engaged.

The TNA role has attracted individuals who have wanted to serve in direct care capacities but might not have had a pathway previously. The TNA role also supports our nation’s refugees and immigrants in receiving vital training to enter the long term care field.

Over the course of the pandemic, TNAs have gained thousands of hours of on-the-job, supervised training and experience in providing critical services and support to residents in nursing homes and assisted living communities. The 1135 waiver ended June 6, 2022, and only four months were given for TNAs to become CNAs or they would not be able to continue working in long term care communities.

State capacities were not sufficient to accommodate the training and testing needs of thousands of TNAs in this short time frame. H.R. 468 would extend the time to 24 months for TNAs to train and test to become CNAs.

Take Action

Advocating for meaningful, supportive solutions to the workforce challenges facing long term care facilities is critical. Let’s rebuild and strengthen the long term care workforce and protect seniors’ access to care.

1. Tell key decision-makers (i.e., the Centers for Medicare & Medicaid Services and the Biden administration) that an unfunded nursing home staffing minimum requirement won’t solve the long term care labor crisis and will only threaten access to critical long term care for our nation’s seniors. Recommend AHCA’s Care for Our Seniors Act as a better policy for our industry.

2. Advocate for the passage of H.R. 468 to allow time for TNAs to train and test to become CNAs, a vital part of the caregiver workforce.

For more information on AHCA/NCAL advocacy efforts and how you can help, go to www.ahcancal.org/Advocacy.