According to federal data, there are over 400,000 fewer employees of nursing and residential care facilities today than there were in March 2020.
It was on March 13, 2020, that an order from the federal government closed nursing homes (which are federally regulated) to visitation, communal dining, and group activities in order to avoid COVID-19 transmission. Similar restrictions were imposed by states for other state-regulated congregate care settings.
For an excruciatingly long period in 2020, to work in a long-term care facility was to be at the epicenter of risk and death from COVID-19. It was not until late December of that year that vaccinations began for residents and staff. Many of the residents who died in nursing homes were the long-stay residents who become like family to those who care for them.
It is not surprising that amidst challenges and tragedy long-term care facilities saw an exodus of staff. That exodus is part of what is now called the “Great Resignation” that occurred as workers in various sectors reevaluated their jobs in the face of COVID-19 disruption.
Those working in long-term care, a workforce data shows is largely comprised of women and people of color, had been long marginalized before the pandemic. For caregivers, work in hospitals was deemed more prestigious, as hospitals, with their private insurance revenue, do not face the challenging finances of caring for a predominantly-Medicaid population.
And during the pandemic, it was clear hospitals were the top priority of policymakers, with obvious examples including the fateful decision of former New York Gov. Andrew Cuomo to compel nursing homes to accept hospital discharges positive with the lethal virus and then lie about the catastrophic outcome.
Now, to an unhealthy degree, long-term care facilities are being forced to utilize out-of-state staffing agencies simply to maintain their staffing. A bipartisan group of 195 House members has submitted a letter to the Biden Administration urging an investigation of the price-gouging that such agencies are engaged in, although even in that letter the only provider type directly mentioned are hospitals. Yet, assuming the Biden Administration launches an investigation, a resolution could take years. One national staffing agency reported a 1,100% increase in its net income last year.
The staffing crisis has grown so desperate that some states are deploying the National Guard in nursing homes, with Minnesota activating Guard members to serve as certified nursing assistants and temporary nursing aides. Yet stopgap measures will not rebuild staffing, let alone rebuild it in a way where facilities can responsibly restore occupancies to levels that are financially sustainable.
In 2020, when nursing homes were in the headlines for COVID-19 deaths, it seemed that the longstanding societal neglect of our most vulnerable citizens might be redressed. In a 186-page report, a federal commission recommended a permanent 12% increase in annual per-bed Medicaid payments — or about $10,000 a bed — to largely be used to increase staff salaries. That proposal went nowhere, and nursing home care has again been forgotten by the federal government with the reduction in COVID-19 mortality that vaccination brought.
We can contrast policymakers’ inaction on saving nursing home care with the fact that the private insurance industry’s Better Medicare Alliance boasted last month that a record 346 U.S. House members signed its annual letter extolling the virtues of privatized Medicare. That advocacy paid off. Following the letter, the Biden Administration proposed an 8% increase in revenue for the insurance giants offering Medicare Advantage plans.
Adding insult to injury, the federal government has reportedly diverted $17 billion from the Provider Relief Fund to give more money to drugmakers for COVID-19 vaccines. Advocates are imploring Congress to add $20 billion back to assist long-term care facilities. Absent help from the federal government, desperate providers can only look to states. An entire care sector is at the precipice.
(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)