The Burden of Care: Senior health care staffing shortages straining agencies

Jim Edwards: Getting applications is just the start of industry workforce issues.

Cliff Stepp: Demand for care is outpacing workforce availability.

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Although industries that focus on the health and wellness of the older adults are seeing an uptick in needed services due to the aging baby boomer generation, skilled nursing and assisted living facilities are finding it harder to retain staff to meet the demand.

The American Health Care Association and National Center for Assisted Living are calling it a workforce crisis.

Those organizations, representing nearly 14,000 skilled nursing facilities and assisted living properties nationwide, say 86% of skilled nursing facilities and 77% of assisted living facilities are reporting their workforce situations have worsened since June.

Open positions
Local facility administrators say they’re experiencing the trend, too.

Jim Edwards, president and administrator at Century Pines Assisted Living in Ozark, said getting people to even apply is the beginning of the issues.

“It’s been a constant challenge to find people to just apply for positions,” he said. “If they apply for the positions and we set up interviews, they do not come for the interviews. If they come for the interviews and they say they are accepting the job, the trend is that they don’t actually come to begin work. We never hear from them again.”

Edwards said his colleagues around the state say they’re in the same boat for hiring.

“Everyone is seeing the same type of trend,” he said.

On the ability to hire new staff, data from the AHCA and NCAL show that 7 out of 10 facilities recently surveyed say they’re having a very difficult time filling positions.

The reasons for the hiring struggle, according to the survey, has to do with COVID-19 vaccination requirements, fear of contracting the virus, unemployment benefits discouraging work, lack of interested or qualified candidates, current financial situations and the lack of funding for facilities to offer competitive wages.

Entry-level wages offered to candidates at assisted living facilities, home care and skilled nursing facilities in the Springfield area range from about $11-$15 an hour, according to sources Springfield Business Journal interviewed for this story. The state minimum wage will rise to $11.15 an hour in 2022.

Edwards said although many industries are facing staffing shortages, caring for the older adults is not as easy as raising the cost of care to balance growing labor costs. Most seniors, he said, are on a fixed income and are limited on what they can regularly pay for care.

“You can increase the cost of food to someone who is shopping or you could increase the price of a burrito at a restaurant,” he said. “We can’t just increase the cost of care on an ongoing basis.”

Staff retention
Matthew Gould, administrator at The Manor at Elfindale, said several factors play into staff retention, and it’s something individual facilities should be tracking.

Gould said The Manor, a skilled nursing facility, has about 140 staff members and a roughly 60%-75% retention rate.

He said positions like certified nurse assistants have long had a high turnover rate, and there have been shortages in nursing for a few years.

While he acknowledged it’s a trying time for the industry, it’s not all “doom and gloom,” and the employees retained are making all the difference to the seniors they care for.

“I’m surrounded by good people,” he said. “It’s just gotten harder to find good people.”

The national survey from the AHCA and NCAL indicated over 99% of skilled nursing and assisted living facilities have had to ask current staff members to work overtime. Both Gould and Edwards confirmed they have asked staff members to work overtime.

“I am so grateful to the people that show up shift after shift and day after day to improve the quality of life of the people who live here,” Gould said.

Getting well
To address the staffing shortages, the AHCA and NCAL are proposing Congress pass the Care for Our Seniors Act.

The legislation calls for reform in the areas of improving the quality of care available, workforce support and improvements, making systems more resident-driven, and modernization of focus on resident safety and dignity.

Cliff Stepp, president of Integrity Home Health Care LLC – which has a workforce of 1,100 that focuses on in-home health for the needs of various individuals, including older adults – said although the COVID-19 pandemic has made staffing situations worse, it’s not a surprise that there is a workforce shortage for companies that focus on the care of older adults because of the current level of demand.

“This is a problem we’ve seen coming for a long time, but we’ve had a demographic change,” Stepp said. “With boomers, we have 10,000 people a day turning 65. The amount of people that need care, and are going to need care, is far outpacing the folks that are available to provide that care.”

Stepp said Medicare, Medicaid and all health insurances that help pay for services for seniors play a major role in an overall outlook of senior health, the staffing of those jobs and the services provided.

“They’ve got to start recognizing the value of a caregiver position, and how in the big scheme of things, paying for that level of care reduces their overall cost,” he said.

Stepp said if companies that provide care for seniors get higher reimbursements, it would allow for home care providers, and others, to be able to offer more to employees.

“We will start attracting more people, and more qualified people where they can make it a career,” he said. “It’s an incredibly valuable service that they provide.”

Care outlook
The workforce situation already is impacting the number of residents senior care facilities can house, and industry leaders say it could worsen without changes for improvement.

According to the AHCA/NCAL survey, 58% of nursing homes and 28% of assisted living facilities are having to limit new admissions, but Century Pines hasn’t had to do that just yet.

Edwards said the state requires assisted living facilities to have at least one caregiver per 20 residents at night and one per 15 during the day. He said Century Pines currently has 67 residents and about 35 total staff.

Edwards said even with a 5.9% increase in Social Security benefits planned, it won’t be enough to help cover the existing needs of seniors, including the cost of care.

Labor costs at Century Pines have gone up 25% over the last year, Edwards said, and the facility has only raised rates for residents by about 5%. He said there are no signs of that slowing down with the escalating minimum wage.

While stress levels have been high, Edwards said the problem can only be solved one day at a time and, in the meanwhile, seniors deserve the best.

“They are our older population and they’ve worked hard,” he said. “They should get good care.”