AHCA sounds alarm on nursing home staffing crisis

Nursing homes have 210,000 fewer workers than before the pandemic, bringing workforce levels to the lowest they have been since 1994, according to a trade group representing nursing homes.

The long-term care jobs report, released last week by the American Health Care Association and National Center for Assisted Living, outlines the sector’s dire staffing conditions.

While nursing homes have filled a monthly average of 3,700 jobs over the last nine months, at that rate it would take nursing homes until 2027 to return to pre-pandemic staffing levels, the AHCA/NCAL found. 

A lack of outside funding and prioritization from federal and state public health officials has made it challenging for nursing homes to address staffing shortages and closures, as many do not have the funds to hire staff or use updated technology to streamline operations, the organization said in a statement. 

“We need long-term investments and programs from policymakers to attract individuals to serve our nation’s seniors,” the AHCA said. “The financial reality is that nursing homes are on a fixed government budget, and for decades, Medicaid has failed to adequately fund the actual cost of care for our nation’s most vulnerable.” 

Medicaid covers services for 62% of long-term care residents, amounting to $50.8 billion in revenue for nursing homes, according to a Kaiser Health News report.

The trade group’s report comes as the Biden administration takes steps to address the quality of nursing homes by improving accountability and staffing efforts. Over the past year President Joe Biden has proposed a number of policies to address nursing home quality and safety, including a plan to set minimum staffing requirements. The plan was opposed by some in the industry, including the AHCA, for its expected cost.

To increase staffing minimums to the recommended ratio of 4.1 hours of nursing care per resident per day, nursing homes will require around $11.3 billion in additional funding annually, according to a report by accounting and consulting firm CliftonLarsonAllen. 

Last week, the Biden administration, along with the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, announced actions to make nursing home citations more visible to families and reduce the use of antipsychotic medications.

Trade groups estimate the cost of the changes will be too great for nursing homes to bear. As a result, the industry has looked to Congress for funding.  

Since March 2021, the AHCA has been advocating for Congress to consider the policy proposals in its reform agenda, the Care For Our Seniors Act, and incorporate them into relevant legislation. The proposals include workforce improvements and offering loan forgiveness, tax credits, affordable housing, child care assistance and immigration reform to long-term care professionals. 

The AHCA and LeadingAge, a system of nonprofit aging services providers, have suggested increasing Medicaid reimbursement rates to equal the cost of care, using additional federal funds to pay for nursing facility rates and establishing federal guidelines for reasonable cost definitions. 

Even though most nursing home providers have increased wages and offered bonuses to recruit and retain staff, 96% still have trouble filling positions, according to a June 2022 AHCA survey. Around 78% have hired temporary agency staff to adjust for shortages.

The average nursing home employee turnover rate is 53.3% within a year, according to a 2022  study by the Long Term Care Community Coalition, a New-York based nonprofit organization focused on quality care. 

The exodus of staff meant that only 26.8% of nursing homes met the essential total care staff threshold of 4.1 hours per resident day in 2022, the coalition found. 

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