Study Examines How Nursing Homes Responded to Staffing Shortages

The impacts of the COVID-19 pandemic on nursing homes, their residents, and staff drew attention to the staffing shortages the industry had already been facing pre-pandemic. Those shortages had many impacts on nursing homes, from affecting mortality rates to increasing staff turnover.

KFF released data on the nursing home staffing shortages in 2022. According to the data, more than 200,000 COVID-19 deaths to long-term care residents and staff occurred, but 150,000 of those deaths occurred among residents and staff in nursing facilities that are certified to receive Medicare and/or Medicaid payments.

The January 2023 American Health Care Association State of the Nursing Home Industry surveyed 524 nursing home providers. According to the report, 86% of nursing homes experienced moderate to severe staffing shortages, and 96% struggled to hire additional staff. Additionally, 78% of nursing homes reported that they had to hire temporary agency staff to fulfill their staffing needs.

A new study delves into the effects of these staffing shortages even more, and its findings highlight the serious implications that staffing shortages have for the nursing home industry.

How Nursing Homes Dealt with Pandemic Staffing Shortages

The report, Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic, uses qualitative and quantitative date from 40 US nursing homes. Nursing home administrator interviews were conducted from July 14, 2020 to December 16, 2021. During the interviews, administrators discussed how they dealt with staffing shortages.

The report found three major themes in how nursing homes responded to these staffing challenges:

1. Nursing homes experienced substantial staffing shortages

Administrators described ongoing challenges in maintaining safe staff-to-resident ratios and remaining compliant with staffing requirements. In an effort to compensate for limited staffing, administrators implemented strategies such as increasing staff overtime and cross-training existing staff. Multiple administrators described higher staff-to-resident ratios. For example, one administrator noted that the facility’s standard ratio for CNAs to residents is 1:10, but during the pandemic, ratios increased to 1:13 or 1:14.

Study data also reflected this trend, showing an increase in staff hours per resident day at the beginning of the pandemic. Those hours decreased over time.

2. Hiring agency staff to offset staffing shortages

Nursing home administrators started to rely on agency staff to meet staffing requirements during the pandemic. In some cases, the pandemic marked the first time that administrators had to rely on agency staffing.

While agency staffing allowed nursing homes to reach their staffing requirements, this solution posed several significant problems. Since hospitals and other health care operations also relied on agency staffing, demand increased and agencies charged increasing rates. Thus, staffing wasn’t always reliable.

3. Limited new admissions

With limited staffing, nursing home administrators weren’t able to continue to increase census and bring in new residents. Data also reflects a significant decrease in resident census from March 2020 to January 2021. While census has increased through 2022, many nursing homes are still working to rebuild census to pre-pandemic levels.

Lasting Impacts of Staffing Shortage Solutions

These themes have long-lasting implications for the nursing home industry. Nursing homes shouldered the financial burden of increased overtime pay and high agency staff costs.

Those costs were unusually high during the pandemic. According to KFF Health News, the average weekly travel nurse pay was $1,896 in January 2020. By December 2021, that average pay had increased to $3,782 per week.

Additionally, since new resident admissions decreased, nursing homes experienced reduced revenue, which made coping with higher operational costs even more difficult.

While coping strategies, like relying on agency staff and operating at a higher resident-to-staff ratio worked temporarily, they are not long-term solutions. Staff had to manage the demand of caring for more residents while also supervising and training agency staff unfamiliar with the nursing homes. Such challenges can contribute to staff burnout, which can lead to an increased strain on the workforce.

The staffing shortages faced by the nursing home industry (as well as the senior care industry as a whole) have serious implications not only on quality of care and staff burnout, but on nursing home profitability. While staffing agencies offer short-term solutions, used long-term, they may be financially unfeasible. Other, innovative solutions for attracting and retaining staff are going to be essential in keeping nursing homes operational and profitable.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.