Troubling Staffing Shortages in Nursing Homes
There is a glaring shortage of nurses and aides in the approximately 15,000 nursing homes across the United States. This shortfall is particularly concerning as these homes accommodate around 1.2 million vulnerable Americans, many of whom are frail and elderly.
The Need Unmet
Many elderly residents can’t move or even turn without assistance. They get bedsores, lie in soiled briefs waiting for someone to help them, or even have accidents because no one is available to assist them. In some cases, they are subject to physical and chemical restraints to make them compliant. All these issues are the result of understaffing and an inability to meet their needs.
State Laws Fall Short
Several states, including California, Florida, Massachusetts, New York, and Rhode Island, have attempted to enhance the quality of care in nursing homes by mandating minimum care hours per resident. Unfortunately, the enlistment of these laws has not guaranteed better staffing. Numerous nursing homes continue to operate with staffing levels below the required minimum, often with regulators’ approval or without any repercussions.
The Pursuit of Adequate Staffing
The Biden administration is currently trying to guarantee adequate staffing in nursing homes, similar to previous unsuccessful state attempts, through stricter standards. Federal rules set in April are likely to require four out of five homes to increase their staffing levels. Nonetheless, this plan has its weaknesses, including underfunded health inspectors for enforcement and a lack of explicit penalties for violations.
Impact of Covid-19 and Low Pay
The situation further deteriorated when the Covid-19 pandemic swept through nursing homes, claiming over 170,000 lives and driving employees away. Nursing assistants, who are among the lowest-paid employees in the industry, earning about $19 an hour on average, frequently opt for less strenuous jobs in retail and fast-food outlets that pay equally well. As a result, the turnover rate in nursing homes is alarmingly high.
Industry Challenges
The mostly for-profit industry puts the blame on reduced reimbursement rates by Medicaid for staffing issues. Nonetheless, research and court evidence suggest that nursing home owners and investors often make considerable profits that could be reinvested into better healthcare provision.
Legal Hurdles and Federal Enforcement Delays
Trade groups have protested against the stringent state standards and have filed a lawsuit to block the new federal standards, citing difficulties in filling job positions. Furthermore, federal enforcement of these rules seems to be a distant reality, with nursing homes given up to five years to comply with the new regulations.
The Human Price Paid
Amid these systemic issues, it’s the nursing home residents who pay the ultimate price. Reports indicate numerous cases where residents were neglected due to overwhelmed nursing staff. Incidents of residents falling due to lack of assistance or found in compromising situations due to inadequate attention are not uncommon.
Bottom Line and Potential Solutions
The situation is further complicated by the financial struggles of even non-profit nursing homes, leading some to shut down or convert into assisted living facilities. While nursing homes contend with financial and staffing issues, the debate is ongoing about whether the problem lies with funding, or the industry’s prioritization of profits. It is clear though that sustainable solutions are needed, and fast.