Columnist Kimberly Marselas considers whether staffing demands are breaking the system.
Kimberly Marselas

The national media hasn’t missed many chances to hammer home nursing homes’  “failures” during the pandemic. Now that they’re turning the spotlight on the sector’s staffing crisis, ingenious advice and outright attacks from commenters are sure to follow.

Last weekend, the Washington Post’s Rebecca Tan told the all-too-familiar story of LaToya Francis, a CNA with eight years’ experience. She served as a sort of everyman of skilled nursing workers in this piece, which also trotted briefly into labor trends and payment issues exacerbating the industry’s workforce crisis.

Working in a nursing home in Washington, D.C.’s grittiest quarter, Francis said she often is the only direct care worker on her unit during a 12-hour overnight shift. In addition to the on-the-job anxieties that presents, she worries about bringing COVID-19 home to her asthmatic son, a daughter too young to be vaccinated or her fiancee, who has sickle cell anemia.

Some 420,000 workers like Francis have already left nursing homes and similar settings since February 2020. Francis may soon add herself to that stat, but she remains torn over wanting to sustain patients who need her and finding other employment that might better sustain her own family.

While Francis is as concerned as ever about her residents, commenters immediately pushed her to leave.

“LaToya, get a job at a hospital,” wrote one responding to Tan’s Twitter thread Sunday. “They will pay most of your tuition for nursing school. You can still take care of patients.”

But who will take care of her current patients? What happens when there’s no one left to cover the unit?

It’s so easy to have compassion for an individual facing unfair challenges, to cheer on LaToya The Mom. Those keyboard pundits never ponder how we could keep LaToya The Worker happy and support the nursing home system to which she has already devoted years of her life. 

Herein lies the rub: Many of us want more for deserving workers but know that their ability to find it right now might mean a move outside skilled nursing. And that could very well mean less of a life for vulnerable nursing home patients.

Why can’t we improve standards for both without breaking either?

Some providers are doing what they can, creating wage packages that cost them millions last year. But without increased revenues, they won’t be able to keep growing pay rates.

The current long-term care system is either chronically underfunded or being destroyed from the inside out by corporate greed. Maybe both, depending on who you ask. Any worthwhile legislative change must ensure more money goes to landing and keeping workers. Otherwise, staff like Francis will continue to get less than they earn.

But there’s also a chicken-and-egg scenario happening right now. States that have pushed to tie additional government spending to direct care wages also want to see staff numbers increase. There is no one to hire, and staffing initiatives demanded by consumers and unions alike are on pause.

So the LaToyas of the world continue to struggle on empty floors in the late hours of night. No one who hears their horror stories wants to jump into an environment where wages could soon improve.

Workers in understaffed facilities will continue to face gut-wrenching decisions about who to prioritize, and when — if ever — they can put themselves first. It’s an unfair ask of healthcare heroes, unfair of anyone really. It’s a reason so many are leaving the U.S. workforce.

That’s what makes it hard to begrudge a LaToya Francis the choices she just might have to make.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

The opinions expressed in McKnight’s Long-Term Care News are not necessarily those of McKnight’s.