Nursing homes are suffering a staffing crisis. Although worker shortages were an issue before COVID-19, the industry has lost some 235,000 jobs since the beginning of the pandemic, representing a 15 percent reduction of the workforce. The crisis — driven by dangerous working conditions, poor pay and benefits, burnout and more — has led to some of the worst staffing shortages the industry has seen. An AARP analysis found that at least a fifth of U.S. nursing homes have reported a lack of staff every month since summer 2020, when the federal government began collecting such data. In recent months, the shortages have grown worse.
Studies show that low staffing levels in nursing homes translate into poorer quality care for residents. The problems residents can experience because of inadequate staffing include decreased physical functioning, urinary tract infections, higher hospitalization rates, weight loss and dehydration, increased COVID-19 cases and higher mortality rates.
Yet U.S. nursing homes are not subject to federal minimum staffing requirements. Federal law only requires nursing homes to provide “sufficient” nursing staff to meet residents’ needs. Other than mandating that a registered nurse be on duty for eight hours a day, and that facilities have around-the-clock licensed nurse services, what counts as “sufficient” is subjective.
President Joe Biden has announced a plan for a federal minimum staffing requirement that could mandate certain amounts and types of care per resident for the nation’s 15,000 federally funded nursing homes, which AARP supports. But such a rule is not expected until next year.
In the meantime, there’s a patchwork of state staffing requirements for nursing homes, including at least 18 states that have none. While some states are working to introduce or strengthen requirements — with AARP’s support — others, like Florida, are doing the opposite.
Both the lack of staff and standards are placing nursing home residents in danger, experts say. “We’re in the biggest workforce crisis in long-term care service that I’ve ever seen,” says Robert Applebaum, a researcher at the Scripps Gerontology Center at Miami University in Ohio, who has studied long-term care for 40 years. “Families do need to be more diligent than ever before.”
If you currently have a parent, spouse, sibling or other loved one in a nursing home, ask yourself these questions:
1. Have I checked the data?
Every nursing home that participates in the federal Medicare program, which is the vast majority of U.S. nursing homes, is required to submit staffing data to the federal government. The data is posted on the Medicare.gov Care Compare website, where you can see a facility’s averages for several staffing categories, including overall staffing, weekend staffing and staff turnover, and check how it compares with other facilities in the state and nation. Each nursing home is rated in a variety of categories, on a five-star scale. “I personally would avoid any nursing home with less than four stars for their overall and staffing ratings,” says Richard Mollot, executive director of the Long Term Care Community Coalition (LTCCC), a national nonprofit advocacy organization.
A 2001 report commissioned by the federal government found that at least 4.1 hours of direct nursing care per resident per day was needed to prevent harm or jeopardy to residents. It recommended that at least 45 minutes of that care be provided by a registered nurse (RN). Nursing homes are not required by federal law to meet these levels, but many nursing home experts say they’re good benchmarks for consumers.