In June, the number of people working in the nation’s nursing homes finally exceeded the employment level in February 2020, just before the COVID-19 pandemic.
While this was good news, it’s worth noting that the number of Americans 75 and older — the age demographic most likely to need long-term care — has grown by an estimated 10% to 15% over that period. Ideally, nursing homes employment growth would have kept pace, even with robust home and community-based settings, which nursing home providers support, reserving nursing home care for those needing or wanting it.
The average taxpayer might be surprised to know that around 260% more federal COVID-19 relief funds were directed at the airline industry than nursing homes, and if you’ve had the misery of flying lately you might ask how that investment worked out. Nursing homes were affectively abandoned to rebuild their workforces one employee at a time, while suffering the unchecked predations of the worst national staffing agencies that could hold them hostage to fill shifts.
Even today, the workforce recovery is precarious. A July national survey of predominantly nonprofit providers found that just over one-third of the workforce is turning over annually, and it’s not just caregivers — positions essential to the care environment like dietary staff are hard to hold onto.
Unlike a restaurant, a nursing home, especially one serving the Medicaid population at a loss, cannot simply raise prices to meet wage expectations (or, say, the price of beef, up over 13% since last year). And yet staff continuity is not only good for the residents but reassuring too. Would you want to awaken to a stranger at your bedside?
In New Hampshire, the inability for many providers to fill caregiving positions has led to access issues, because a nursing home cannot admit those whose needs it cannot responsibly serve. Thus a number of facilities have waiting lists, and this can back up hospitals with patients awaiting discharge. It can actually create hospital patients where those in home and community-based settings needed to step up, if even temporarily, to a nursing home level of care that is inaccessible.
Hillsborough County Nursing Home provides a good snapshot of workforce needs. It’s looking to fill 15 full-time licensed nurse positions, and hire 32 full-time licensed nursing assistants, with very fair wages and benefits, but where are New Hampshire licensed workers to be found? A couple more rural county-owned facilities are forced to find a quarter, to over half, of their caregivers through out-of-state “travelers” at a premium rate, because there is no other option to meet resident care needs.
Some positions are nearly impossible to fill. The University of New Hampshire School of Nursing recently had over 2,000 applications for just 120 slots, and there’s no guarantee that the 120 future registered nurses will choose to stay in New Hampshire. If they do, there will be fierce competition among all health care sectors for their talents.
This is why the only health care positive in last year’s federal budget reconciliation law, the Rural Health Transformation Program, is so essential. Gov. Kelly Ayotte was able to put together an application that obtained a federal grant larger than those given many bigger states, including Massachusetts and even Pennsylvania.
This money must be used to expand access to caregiver training and keep caregivers here. Because the demand for care isn’t waiting. Nationally, freestanding nursing care occupancy has hit its highest level since 2016.
New Hampshire has one of the nation’s four oldest nursing home populations. It is imperative that sustainable Medicaid funding and workforce infrastructure exists to serve our most elderly and infirm Granite Staters.
Brendan Williams is the president & CEO of the New Hampshire Health Care Association.