A stressed nurse
Photo credit: The Good Brigade/Getty Images Plus
A stressed nurse
Photo credit: The Good Brigade/Getty Images Plus

The long-term care sector is still struggling to rebuild to pre-pandemic staffing levels while also bracing for negative effects of new federal regulations, according to the “State of the Sector” report released Tuesday by the American Health Care Association. 

Of nearly 450 nursing home providers surveyed, two-thirds are concerned that escalating workforce challenges may force them to close their facility. More than 70% of nursing homes reported staffing levels lower than before the COVID-19 pandemic, with fully 99% saying they are hiring for open positions.

The report was released amid final deliberations on a first-ever final federal nursing home staffing mandate from the Centers for Medicare & Medicaid Services. It also comes just days before President Biden’s State of the Union address Thursday — an occasion he has regularly used to call for toughened nursing home regulations

Nursing homes want the same increased staffing levels as federal regulators, but need help achieving those goals, said Mark Parkinson, president and CEO of AHCA.

“Our updated State of the Sector Report demonstrates clearly what nursing home providers across the country already know: The ongoing labor shortage is nothing less than a crisis for our sector,” Parkinson said in a statement accompanying the report’s release. “Nursing homes want to strengthen their workforce, but they cannot do it alone. We need collaborative solutions, not one-size-fits-all mandates, to protect access to care for all seniors.” 

Staffing ‘sepsis’

According to the survey, nursing homes have tried numerous tactics to increase interest in their open positions, such as raising wages (90%), offering signing bonuses (78%) and paying for staff’s education (69%). Despite these measures, 65% of facilities report needing 1 to 6 months to fill positions, while 15% say even 6 months is not enough. 

The inability to secure more staff contributes to what may be the most potentially dangerous trend revealed in the survey, according to Melissa Brown, chief operating officer at Gravity Healthcare Consulting — that 46% of nursing homes are limiting admissions and 20% have closed a unit or wing entirely.

“We are seeing providers across the nation either turn away admissions, decertify beds, or transition beds over to private pay assisted living,” Brown told McKnight’s Long-Term Care News Tuesday. “With this reduced access, and the likelihood of many more SNFs closing in the next few years due to negative margins reported in the study, this only furthers the socioeconomic health disparities and reduces access to care for the most vulnerable.”

As a result of the estimated $7 billion price tag of the CMS staffing mandate, more than 280,000 residents could be displaced by skilled nursing facility closures, according to AHCA estimates.

“The staffing mandate is not the solution,” Brown agreed, “and in fact it is the bacteria in the wound that will cause SNF sepsis — a systemic shutdown of SNFs across the country.”

Addressing the crisis

Still working toward the pre-pandemic staffing levels and faced with the looming requirement to hire even more, the sector may need to rely on new strategies for boosting the workforce, according to Brown.

“Improving the number of qualified immigrant nurses and therapists, and the utilization of these immigrants in SNFs is a key,” she told McKnight’s. “Broadening SNF access to additional workers is the quick fix that can help to save skilled nursing today.”

As the staffing crisis has worsened, immigrant certified nursing assistants have already been one of the few points of stability in an otherwise flagging workforce. 

Brown also suggested more expansive educational incentives for new care workers.

“Long term, we really need to think about how to incentivize students to seek a nursing or therapy career in skilled nursing,” she said. “A rebate or student loan forgiveness program that applied to all therapists and nurses for each year they work in skilled nursing could really have a meaningful impact.”

As the proposed staffing mandate pushes forward, however, such solutions would almost certainly be too slow to match the new regulation that sector leaders have frequently called an unfunded and one-size-fits-all mandate.