In mid-September, we at the Pennsylvania Health Care Association (PHCA) reached out to our members, including nursing homes, personal care homes and assisted living communities, to better understand the ongoing challenges facing the frontlines of senior care during the COVID-19 pandemic.
We conducted a survey and asked questions regarding the workforce shortage, the impending federal vaccine mandate and the overall operational viability of the sector.
We expected the results to be somewhat bleak, but ultimately encouraging. After all, COVID-19 case counts were dropping across Pennsylvania and it appeared as though we were finally emerging from the darkest days of the pandemic.
As we began to receive responses, however, it became abundantly clear Pennsylvania is in the midst of a long-term care crisis.
It bears highlighting a few results from our survey, in case you’re unsure of what “crisis” means in our current environment of hyperbole:
- Pennsylvania providers lost nearly 20% of their workforce in the first 18 months of the COVID-19 pandemic;
- Nearly half of all nursing home respondents revealed they had more than twenty open positions;
- Nearly 70% of respondents were struggling to meet minimum staffing requirements, let alone a proposed 4.1 PPD (which is currently being shepherded through our state’s regulatory process);
- Seventy-five percent of respondents had restricted new admissions, simply due to a lack of trained, qualified staff. In other words, they were forced to turn away vulnerable senior citizens in need of care.
So, what do long-term care providers do in the face of these concerning trends?
They continue to care for their residents, of course. But to do so, they need support.
And to find that support, providers turned to staffing agencies — partners in the long-term care continuum — that support the care of their residents by helping to fill open shifts and find frontline workers.
Since March 2020, the reliance on agency staff in Pennsylvania has dramatically increased. Our survey found 70% of administrators and executive directors were relying on staffing agencies just to meet minimum requirements — a percentage that has likely increased since we asked in September.
Naturally, with increased demand comes a commensurate increase in rates. But some staffing agencies have seized on this opportunity and the resulting dramatic increase in wages for temporary CNAs, LPNs and RNs is now bordered on — and in some cases exceeds — price gouging.
As the workforce challenges for nearly every industry become more difficult, our full-time, frontline caregivers are being recruited away from our providers, then leased back to them at two, three or four times the cost. At a time when our state’s Medicaid reimbursement hasn’t seen an increase in nearly ten years, this is, quite literally, pushing nursing homes, personal care homes and assisted living communities to the brink of financial collapse.
After all, 81% of all nursing home care in Pennsylvania is paid for by Medicaid and Medicare. Providers simply don’t have the luxury or authority to raise the cost of their product or raise taxes to meet this new “free market” rate. And given a $50 per resident per day Medicaid shortfall, it’s no wonder the average operating margin for Pennsylvania nursing homes was -2.4% before the pandemic began.
Something needs to change.
A few weeks ago, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) sent a letter to the Federal Trade Commission, requesting the commission’s assistance “with an anticompetitive practice with direct care staffing agencies” and urging it “to protect consumers from anticompetitive and unfair practices.”
In Pennsylvania, we are looking to our policymakers for support. We hope to end the harmful practice of gouging long-term care providers, residents and taxpayers. Legislation recently introduced in our state capitol would not only establish maximum rates a staffing agency can charge — a critical tactic that has yielded results in Massachusetts and Minnesota — but would provide government oversight to the most unregulated component of the second-most regulated industry in the nation.
By advancing this legislation in Pennsylvania, we can take steps to stabilize the long-term care continuum — including contract staffing agencies — both today and into the future.
And the next time we survey our members, maybe the feedback will sound a bit better.
Zach Shamberg is the president and CEO of the Pennsylvania Health Care Association (PHCA), a statewide advocacy organization for Pennsylvania’s most vulnerable residents in long-term care and their providers of care.
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.