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When it comes to hiring, 55% of nursing homes and senior living facilities say they are now competing with staffing agencies for the same scarce supply of workers.

That’s just one area of concern for nursing homes, which used to compete almost entirely with other senior care providers for job candidates, according to recruiting and workforce management firm OnShift, which on Wednesday released results of a survey of more than 2,000 industry professionals.

This year, 62% of senior care providers called hospitals and health systems their top competitors for talent, followed by senior care organizations at 61% (down from 89% just a year ago), and home health organizations at 53%. Overall, providers reported competition from non-healthcare sectors, including hospitality, retail and the gig economy, was up 81%.

In many ways, the annual survey reinforced field reports from across the nation, as well as cries for help from many state-based provider organizations. Nursing homes have lost some 220,000 workers since the pandemic’s start, according to federal statistics.

One telling OnShift result may cast a longer shadow over the industry: Seventy percent of respondents believe managing labor costs will be as difficult as it is now or worsen over the next three years. 

“Overall, 77% said it’s difficult to recruit and hire workers,” Ray Desrochers, president and COO of OnShift, told McKnight’s. “Based on these responses, the real challenge is that employees are being recruited from a number of other industries including hospitals, staffing agencies, and hotels, restaurants, retail and gig services.”

This is OnShift’s third annual workforce survey, but the first to include agencies as potential competitors. Providers have been increasingly frustrated by what they call anticompetitive poaching, or the agencies’ recruiting of full-time workers to become agency or travel workers.

Earlier this month, the Kentucky Association of Health Care Facilities /

Kentucky Center for Assisted Living reported 3,000 vacancies in that state’s long-term care facilities with many of them among nurse aide, licensed practical nurse, dietary, activities, maintenance, business office, director of nursing and administrator positions. Sixty percent of KAHCF respondents were using agency staff, while respondents also listed those agencies as one of the main reasons their employees are leaving (along with lack of funding for competitive wages).

But agency competition is far from their only concern.

Three-fourths of providers told OnShift they struggle to consistently fill shifts. While 76% turn to overtime first, there aren’t enough workers to staff shifts consistently. Respondents reported a 71% increase in agency reliance versus the previous year. Among nursing homes, 52% are “often” relying on agency workers versus 32% among assisted living providers. 

Just over 40% of all providers also are relying more on managers to work open shifts.

Across all demographics, 79% of providers cited staffing shortages as the top workforce challenge. The same share said burnout was the top personal challenge facing caregivers and hourly employees — even as the share of providers who said their employees had COVID-19 safety fell from 65% last year to 46% this year.

To stem the tide, providers have expanded their recruitment efforts to non-traditional segments such as students (72%), family members of residents/ patients (34%) and retirees (28%). 

Often, the struggle is leading facilities to limit services, although the share reporting their ability to staff to meet resident care needs remained flat at 47%. A larger share (85%) of skilled nursing providers, however, reported they found it difficult or “not easy” to maintain or grow census. That compared to 79% of assisted living respondents. 

“With competition for talent shifting so dramatically outside the industry, providers must do more to retain the staff they have, develop inclusive environments, and make the industry more attractive to the nontraditional workforce, such as students, retirees and gig economy workers,” the survey report authors said. 

Both providers and employees said they would like to see increased wages and better staffing levels. They also are aligned on the need for improved communication, more recognition for contributions at work, as well as scheduling flexibility, according to findings.

“The ability to deliver on these expectations will be vital,” the authors observed.

OnShift surveyed 2.050 senior care workers online between Nov. 18 and December 3. Respondents included 8% executives or C-suite leaders, 37% directors or department heads, 33% managers, 10% specialists or staff and 12% in other roles.