Nursing Homes Doing the Best They Can Despite Financial, Hiring Struggles

The pandemic further exacerbated a labor shortage in the industry, with nursing home staffing at a 30-year low.

Nursing homes were the most heavily affected sector of healthcare during the pandemic and  as the industry works toward stabilizing itself  amid an ongoing labor shortage, they're working the hardest to recruit and retain talent, an industry leader says

 Since the pandemic, nursing homes have lost more than  223,000 workers, said Holly Harmon, senior vice president of quality, regulatory, and clinical services for the American Health Care Association (AHCA).

And while nursing homes have been increasing wages more than any other area in the industry—going up by 9.5% in 2020 and 6.3% in 2021—staffing levels are nearing a 30-year low, Harmon said

"What I would say is nursing homes providers have been doing everything they can to address the labor crisis, but nursing homes are uniquely reliant on government funding and therefore the resources are limited," she told HealthLeaders.

The fixed Medicaid reimbursements that nursing homes rely on, Harmon said, don't always cover the total cost of care. That, in addition to rising labor costs, have begun to stretch facilities' resources thin.

"The biggest call for help is that we really need policymakers to put their support behind prioritizing long-term care and support of getting resources and programs that will build a pipeline of caregivers that will sustain nursing homes for today and the future with recruitment and retention," she said.

"And ultimately," she added, "there's not on silver bullet, or one answer to this. It really [requires] a comprehensive set of approaches that we believe would bring some stability to the workforce and support our caregivers into the future."

Despite recent wage increases, due to the economic strain of inflation, nursing homes are struggling to compete with other industry sectors when looking for talent. According to Harmon, 98% of nursing homes are experiencing difficulty hiring staff, with their main obstacle being the lack of interested or qualified candidates.

"Nursing homes would love to hire more staff, more nurses, more aides to support the increasing needs of residents living in the nursing homes," she said. "However, nursing homes cannot meet additional staffing requirements when they can't find the people to fill those open positions, or if they don't have the resources to be able to compete with other employers."

Harmon notes that nursing homes offer an array of benefits such as flexible or self-scheduling, mentorship programs, and career development opportunities, and are continually innovating and developing others to improve their marketability.

Some of these methods include facilities providing childcare assistance and loan forgiveness for employees who've worked there for a certain amount of time. With education, the AHCA's reform agenda proposes developing partnerships with local institutions to help train students, creating a mutual investment where the students are provided on-the-job instruction and the facility has a pipeline of talent.

"Nursing homes also will empower staff, whether clinical or nonclinical, to lead efforts in the home or facility to improve care, and that's really important," Harmon said. "In the culture of the facility, there's multiple efforts that leaders in nursing homes do to have an engaging culture with those individuals."

"We have a number of other ideas of how we can help really elevate the nursing home profession for individuals that are out there and want to serve our elders," she said. "But they aren't able to get their foot in the door because of whatever challenges might exist, and how we can have programs in place that might welcome them and help retain them."