Nursing Home Staffing Plummeted During The Pandemic And Has Yet To Recover

Nursing homes are struggling to regain their footing in the long shadow of the COVID-19 crisis, with employment numbers down sharply from pre-pandemic levels, data shows.

A report published Wednesday by the American Health Care Association and National Center for Assisted Living (ACHA/NCAL) shows nursing homes lost 220,000 jobs from March 2020 through October 2021, equivalent to a 14% drop.

Assisted living communities have also seen a decline in jobs, with employment shrinking by 38,000 over the same period, or 8%, according to data from the Bureau of Labor Statistics.

The numbers stand in sharp contrast to employment figures in other areas of health care, many of which have reached or even surpassed pre-pandemic levels. Outpatient care centers, home health care, physicians’ offices and hospitals have all mostly recovered or even added jobs.

Nursing homes are facing dual crises. At the same time extremely demanding working conditions and low pay are driving workers out of the industry, occupancy rates are declining, sapping facilities of revenue they might otherwise use to lure workers back.

An AARP report in October detailed the causes for the growing number of empty beds, blaming both long-term trends in addition to more recent, severe factors.

Since the 1970s, more seniors have opted to age in place, a choice enabled by growth in industries like home-delivery meal programs and personal care services that make such a choice possible. That’s partially responsible for a 13% occupancy drop over the decades, from a high of 93% in the 70s to 80% in June 2019.

A medical worker poses for a photo with signs saying "Heroes Work Here" outside the FutureCare Lochearn senior nursing facility in Baltimore, Maryland, on April 17, 2020.
A medical worker poses for a photo with signs saying “Heroes Work Here” outside the FutureCare Lochearn senior nursing facility in Baltimore, Maryland, on April 17, 2020.

Tom Brenner via Reuters

With the advent of the pandemic, though, much more drastic elements are at play, not the least of which is COVID itself: An estimated 150,000 nursing home residents have died from the disease so far.

The loss of residents is compounded by halted admissions in some facilities for safety reasons, further chipping away at occupancy. Meanwhile, some hospitals have canceled elective surgeries, cutting off a lucrative pipeline of patients who would often stay in a long-term care facility while rehabbing from their surgery.

“The way that nursing homes have managed to fight back the tide of bankruptcy over several decades … is by taking on more and more short-term patients that are paid highly by Medicare,” Jon Gruber, an MIT economist and the director of the Health Care Program at the National Bureau of Economic Research, told Boston Public Radio last spring.

“The problem is, those patients have suddenly gone away, because no one’s getting knee surgeries. No one’s getting those surgeries where they have to recover in the nursing home,” he said.

But even with a decrease in patients, Gruber told HuffPost at an industry level the volume of work to be done still far outpaces the staff available to do it. The more worrying question, he said, is whether these employees are just slow to return to the industry ― or if they’ve abandoned the sector permanently.

If they don’t, senior citizens will pay the price.

“There is a substantial body of evidence that more staffing leads to better outcomes for seniors,” Gruber said. “The main answer is clear: Raise pay for these incredibly challenging jobs.”

“Short of that, I think we need to figure out a way to make the jobs more attractive – in particular by creating career ladders for long-term care workers so that these don’t become dead-end jobs,” he said.

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