Mirroring the November general election outcome, long-term care leaders were almost evenly split about then-President-elect Joe Biden’s prospects for the industry, according to a new McKnight’s Flash Survey gauging the reactions of more than 300 nursing home leaders.

The survey showed that 39.4% were “more optimistic” while 37.4% were “less optimistic.” Nearly 24% said they thought prospects “are about the same” under a Biden administration as under the Trump administration.

Results reflect answers from 313 McKnight’s Long-Term Care News readers, including owners, administrators and nurse managers, who responded to solicitations emailed from Dec. 7–12 — about a month before a riot broke out at the U.S. Capitol, to which five deaths and dozens of arrests had been attributed, as of press time.

Survey participants said that keeping sufficient staff and rebuilding census levels were their top two concerns for 2021, with the availability of personal protective equipment a distant third.

Meanwhile, fewer than 15% of respondents said their organizations would mandate COVID-19 vaccinations for staff members and more than 70% gave favorable reviews to the point-of-care test kits being heavily pushed by federal officials.

Results also pointed to top strategies being employed to recruit and retain staff and favored ways to help employees’ well-being, among other areas.

Administrators, as a subgrouping of respondents, were the most pessimistic about potential Biden administration policies, while LTC execs were most favorable.

Democrats, in general, are considered more likely to add to the regulatory burden for providers, and Biden has shown signs of upholding that trend. 

“I wouldn’t be more surprised to see more regulations coming,” said Bill McGinley, CEO of the American College of Health Care Administrators. 

Old worries worsen

“Having enough staff” was the nearly unanimous top worry for 2021, with 88% of survey respondents picking it as one of their four biggest concerns. “Rebuilding or keeping enough census” (82%), “Having enough PPE” (44%) and “COVID-related legal/liability claims” (40%) were next in the 10-choice field.

PPE, which would not have been in anybody’s top 10 a year ago, was the No. 3-rated concern for all groups except owners. The top execs elevated legal/liability concerns into the third slot with a 58% vote, relegating PPE to its seventh-most popular pick (27%).

POC tests a surprise

Although well below 20% of respondents said they would mandate that employees get vaccinated against COVID-19, the percentage shot up to 38% when asked whether employees should be required to get vaccinated.

Nearly three-fourths (72%) said that government-supplied point-of-care tests are either great and being used “as much as possible” or “not great, but we’re going to do the best we can with them.” This was in stark contrast to recent government and academic findings that showed a huge percentage of operators were making sparse use of the units, if at all.

How to recruit, keep staff

Offering bonuses to staff for referrals (54%), as well as sign-on bonuses (41%) and bonus pay at the six-month employment mark (18%) turned up as three of the top strategies for improving recruitment and retention.

The next most popular approaches were offering flexible scheduling (38%) and creating part-time positions (33%) to allow workers more family time.

The survey also found that the No. 1 tactic for trying to help staff weather the pandemic has been providing small gifts (such as pizza parties and cookies at nursing stations). A total of 75.1% of respondents said that has been effective.

For the question, “How do you rate your job satisfaction right now?” respondents averaged 6.8 overall on a scale of 1 to 10.