Access to Care Depends on Workforce Solutions
It seems like every industry is struggling with workforce challenges.
In the industry of long-term care – nursing homes, personal care homes, and assisted living communities – staffing challenges are nothing new. Long-term-care providers were battling a shortage of caregivers well before the COVID-19 pandemic. But the last three years have turned the problem into a full-blown crisis, one that will affect all of us at one time or another.
Nursing homes are known, in the most general sense, for providing care to our elderly loved ones and neighbors. But these facilities are also medical centers for residents on ventilators, rehabilitation centers for those in recovery, and safe, secure spaces for loved ones living with dementia and memory loss. These needs require a skilled and robust workforce that works around the clock, seven days a week.
What happens if there aren’t enough workers to do that? That question is being answered across Pennsylvania, as thousands of residents are either being turned away or left to travel longer distances to receive care.
The Pennsylvania Health Care Association (PHCA) has released the results of its 2023 member survey, which identifies waitlists, on average, of three Pennsylvanians per nursing home – and that’s not including the 3.5 people on waitlists for each assisted-living community and personal care home (AL/PC). With nearly 680 nursing homes in the state, that adds up to more than 2,000 Pennsylvanians waiting to receive nursing care. Add in the AL/PCs, and that number triples. These figures will continue to grow. Seniors are the state’s fastest-growing demographic, and the number of adults 85 and older is expected to nearly double between now and 2040.
These waitlists exist because providers don’t have enough staff. In the PHCA survey, more than a third of nursing home administrators revealed that their organizations have 21 or more open positions. How will care be made accessible with these alarming statistics?
One of the primary causes of the workforce crisis facing long-term care is insufficient Medicaid reimbursement. Medicaid currently pays for more than 70% of care delivered but falls well short of covering the actual cost of care. Undercutting payments to providers prohibits them from investing in their workers and makes them less competitive in a shrinking labor pool. Why work in a nursing home when you can make more at a convenience store or gas station?
Pennsylvania finally started to address this issue in last year’s state budget with the first Medicaid reimbursement increase in 10 years, but elected leaders need to maintain that progress to match rising costs. And this is not just a state issue. There’s work that needs to be done at the federal level, too.
PHCA recently sent a letter to the Senate Health, Education, Labor and Pensions (HELP) Committee in response to its request for feedback on how to address the health-care workforce crisis. In the letter, PHCA offered multiple solutions, beginning with a recommendation to delay or cancel the implementation of an unfunded and ill-advised federal staffing mandate. At the direction of the Biden administration, the Centers for Medicare and Medicaid Services (CMS) is preparing to recommend a nationwide staffing requirement for nursing homes. This badly timed mandate not only undermines Pennsylvania’s new staffing requirements but could also force providers to close their doors, discharge residents from facilities, and leave more people at home without skilled nursing care.
The irony is that while U.S. Sen. Bernie Sanders and the other members of the HELP Committee recognize the grave workforce situation, other elected Democratic leaders have urged that the mandate be implemented – regardless of whether caregivers are available or if the mandate affects access to care.
PHCA also recommended a nationwide campaign in K-12 education to focus on careers of compassion, as well as comprehensive immigration reform, the undoing of unnecessary regulatory barriers, and changing the negative narrative that long-term care facilities provide low-quality care. This uninformed viewpoint harms workforce recruitment and retention by discrediting the critical mission and commitment of caregivers.
PHCA has identified real opportunities to address workforce challenges in long-term care. Now we need our elected leaders – in Harrisburg and in Washington, D.C. – to listen.