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Experts say the quality of care at nursing homes is linked to staffing levels. SeventyFour/Getty Images
  • Long-term care facilities report there are more than 220,000 fewer filled positions at their establishments than before the start of the COVID-19 pandemic.
  • However, advocates for nursing home residents say the shortage of workers was an issue before the pandemic due to low pay and working conditions.
  • They say having more registered nurses at long-term care centers greatly improves the quality of care.
  • They add that the extra money in the White House’s “Build Back Better” plan for in-home care could help ease staffing shortages at nursing homes.

You may have heard restaurants and businesses complaining that they haven’t been able to hire enough employees since the COVID-19 pandemic began to ease.

Now, nursing homes say they are also facing critical staffing shortages that could affect the care of older adults.

There’s a new report from the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL), the organization that represents 14,000 nursing homes. It says there are 221,000 fewer filled positions at these facilities since the start of the pandemic.

In a statement, Mark Parkinson, the organization’s president and chief executive officer, blamed the labor shortage on a number of factors.

“As many caregivers are getting burned out by the pandemic, workers are leaving the field for jobs in other healthcare settings or other industries altogether. Chronic Medicaid underfunding, combined with the billions of dollars providers have spent to fight the pandemic, have left long-term care providers struggling to compete for qualified staff,” Parkinson said.

Advocates for care facility residents say the staffing problems at nursing homes and long-term care facilities began long before the pandemic.

They point out that nearly 70 percent of nursing homes are for-profit entities.

Critics say the problem is the pay and working conditions. The facilities, they say, could hire more people if they paid them better.

“Labor shortages were a chronic issue in nursing homes because of relatively low pay, difficult working conditions, and limited benefits for staff. The pandemic has exacerbated staffing shortages,” said Rhonda Richards, a senior legislative representative in government affairs at AARP.

“AARP has long called for fair pay and improved working conditions for those caring for the health and well-being of our most vulnerable residents,” Richards told Healthline.

AARP points to stats showing that, annually, nursing homes have recently received more than $50 billion from Medicaid and more than $25 billion from Medicare.

“They had shortages before because they didn’t hire people. If you pay people… they’ll come” said Patricia L. McGinnis, the co-founder and executive director of the California Advocates for Nursing Home Reform, a statewide consumer advocacy organization.

“They don’t want to pay for anything. They got billions of dollars in COVID relief… billions. And it didn’t go to the staff,” McGinnis told Healthline.

“This has been a disaster waiting to happen,” she added. “Many of these facilities, particularly the 70 percent that are for-profit entities, have been underfunded for years.”

The AHCA/NCAL also says its staffing problems could get worse because of two “unfunded mandates” in President Biden’s “Build Back Better” plan.

The House of Representatives has passed the bill, and it is now waiting for the Senate to vote on it.

One of the provisions in the bill calls for nursing homes to have at least one registered nurse (RN) on-site 24 hours per day.

The AHCA/NCAL says that would prove to be a hardship since the facilities are already facing a severe labor shortage.

However, AARP says that provision wouldn’t kick in until 2024 to give care facilities time to find the personnel.

Experts say there’s a safety issue to consider here.

“Research has consistently found that increasing the presence of RNs in nursing homes is a key driver of care quality and resident safety,” said Richards.

“We’ve been calling for more RN staffing for years,” added McGinnis. “It’s been documented in study after study that those facilities that have higher RN hours have lower morbidity and mortality, and better quality of care.”

The other provision the AHCA/NCAL balks at would require the U.S. Department of Health and Human Services (HHS) to set minimum staffing ratios and require facilities to implement them.

The industry’s organization says that could require nursing homes to hire as many as 150,000 more caregivers at a cost of billions of dollars.

However, AARP says HHS would have up to 4 years to publish the report, which would give nursing homes enough time to prepare and adjust staffing.

The provision would also extend waivers for minimal staffing ratios to rural nursing facilities.

Advocates say there is another provision in the “Build Back Better” plan that most older adults and their families favor.

They add the provision could change the landscape for choices for some senior citizens.

The provision would provide $150 billion in Medicaid funding for in-home care.

“The vast majority of older adults want to live independently in their homes and communities,” said Richards.

She notes a recent AARP poll found that 77 percent of adults 50 and older prefer to remain in their homes for the long term.

“Older adults are looking first at how they can live safely in their homes and communities,” Richards said.