Sometimes those of us in the senior living business think of our business challenges as unique, but this is frequently not the case.
The current nursing home staffing shortage is very much like the current housing crunch. The housing supply isn’t sufficient to meet demand. So, people are bidding up the price of existing structures. These price increases will slow in two situations. One is if more homes are built; the other is if prices get so high that fewer can make a purchase and just stop looking and bidding.
If a public policy goal is to have more homeowners, then the answer to this is to make public policy decisions that facilitate construction.
The supply of nurses and nursing assistants is critically low, just like housing. Currently, those of us trying to hire people are doing all kinds of creative recruiting things, but mostly what we’re doing is raising wages and stealing staff from each other.
This has been good for workers, but it has had no effect on overall staffing levels. New people just aren’t entering the job market, even with much higher salaries being offered universally. One healthcare facility’s gain is another’s loss.
What we are beginning to see occur is, just like in housing, some facilities are being priced out of the market. Those service providers will close, exacerbating an already critical shortage of care options for those in need. It’s safe to assume that the groups most impacted in this situation will be lower-income and probably communities of color. That doesn’t seem to be in the interest of public policy.
In my college economics classes, I learned that resources flow with capital, or said another way, money talks. However, even with a rather dramatic increase in healthcare wages, we don’t seem to be getting people off the sidelines and into the workforce.
Special circumstances in the nursing home industry
Although staffing issues currently exist in many industries, nursing home staffing problems are, in fact, unique in several important ways.
The first is that the industry is not seen as attractive to job seekers. An analysis done in 2021 (looking at 2020 data) concluded that when using a broader definition of “being injured at work” beyond just OSHA injury data and including illness, then working in a nursing home in 2020 was the most dangerous job in America. The risks of working in a nursing home surpassed even logging and commercial fishing.
Typically, high-risk jobs are highly paid because, to attract talent, employers have to compensate for the risk. However, because of the not-for-profit nature of many nursing homes, the salaries are not commensurate with those of other high-risk jobs.
Jobs in nursing homes are also not looked at as “cool,” “interesting,” or, God forbid, “exciting.” Other high-risk jobs have reality shows dedicated to them, like Ax Men or Deadliest Catch. There are no shows currently on Netflix called anything like Chicago Nursing Home or Nursing Assistant Legends. We are proud to work in this industry, and the work is honorable. However, the perception is that while the work is fine, it gives you no reason to brag to your friends.
Finally, the nursing home industry also faces one other very large competitive disadvantage, which is the ability to offer flexibility and remote work. It’s not really possible for our staff members to decide to feed a resident when it fits their daily schedules, and they certainly can’t help someone from a remote location. I have read all kinds of great articles in HR industry publications concerning using flexibility to build your workforce; however, that option is not available to us for most of our jobs.
Nursing home problems are everyone’s problems
It would seem that the public policy interest here is to increase the supply of skilled workers rather than watch the availability of nursing home beds continue to decline — which ultimately hurts the most vulnerable of our citizens. The current situation has the potential to turn into a significant problem for healthcare in general as well. If nursing homes close, hospitals will, in turn, fill with patients who need skilled nursing care. This will ultimately limit the supply of care for all people in every age group.
Possible big picture solutions
When we ask for support, most legislators are very kind, express empathy, and often quote from the movie Dances with Wolves by saying, “We must talk of this again.” So, are there any solutions? I say “yes,” and they don’t require miracles.
One public policy action we could take is offering free federal or state-funded education to people who are willing to pursue a nursing or related field of study. A model similar to military service could be utilized, in which graduates don’t have to pay anything back if they work in the field for a specified number of years. This might be a wonderful opportunity for people struggling to find a financially rewarding career path, as well as others who don’t enjoy large college debt. Having more healthcare workers will benefit the country, not just those receiving the benefit.
Another option we could pursue is a change in immigration rules for skilled healthcare workers. Current immigration policy permits many “skilled workers” to acquire a visa. It would be not insurmountable to offer this route for nurses and nursing assistants in a similar manner as we already do for software engineers. Throughout history, one of the real benefits of immigration in America has been to help the country solve critical labor shortages. What’s old could easily become new again.
Something will probably happen on the housing front because everyone cares. In my limited experience, few people much care about nursing homes. I’m not better. I didn’t spend five minutes of my life thinking about nursing homes until I came to work in the industry. Maybe because hospitals use similar staff pools as nursing homes and nursing home closures will ultimately critically affect healthcare in general, something might happen. The public does seem to notice and has concerns about poor hospital staffing.
There are big ideas that can fix the nursing home staffing crisis. I offered two, but there are likely others. We can do the right thing and take care of your mom and dad. We just need creative and brave people with policy-making responsibilities to take the initiative.
Dean Moore is the Vice President of Work/Life at St. John’s, a full-service senior care provider with options that range from independent living to skilled nursing and hospice in Rochester, NY. He has been in the human resources industry for more than 30 years.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.