The Challenge of Acute Staffing Shortages at Skilled Nursing Facilities

By Joel Landau

The coronavirus pandemic has had a profound impact on businesses—large and small—and among those most affected are nursing homes. Physicians, nurses, and other clinicians are leaving the field in increasing numbers, and skimpily staffed care facilities threaten both patients’ health and the industry’s future. Staffing shortages at long-term care facilities can lead to lower patient-provider ratios, high rates of medical error, and provider burnout.

The Omicron variant and the BA.2 subvariant hit nursing homes hard late in 2021 and in the early months of 2022, with a growing number of infections among both residents and staff. Katy Smith Sloan, president and CEO of Leading Age, a group representing non-profit providers of long-term care for seniors, told NPR that staff shortages due to infection present a severe problem:

“Older adults who live in nursing homes have underlying health conditions. They tend to be frail. They live in a nursing home because they need 24-7 nursing care. And we know from the beginning of this pandemic that that’s the population that was most at risk, and that hasn’t changed.”

Many facilities are responding by closing wings and reducing the number of new patients they accept, which, in turn, has an impact on hospitals and family caregivers. Some hospitals are getting backed up because they are unable to discharge elderly patients who need to enter a skilled nursing facility.

Even before the pandemic struck, healthcare providers were leaving the field. Data published by the Association of American Medical Colleges (AAMC) in 2020 indicated that the U.S. could see an estimated shortage of between 54,100 and 139,000 primary and specialty care physicians by 2033. Specialty physicians, especially those in critical care, emergency medicine, and pulmonary care and who are hospital-based, are needed urgently.

Other key findings from the report include:

  • The aging population will continue to be the primary driver of the increasing demand for doctors from 2018 to 2033. During this time, the U.S. population is projected to grow by 10.4 percent, and the population aged 65 and over is expected to grow by 45.1 percent. So, the demand for specialists who predominantly care for older Americans will continue to rise.
  • A large part of the physician workforce is nearing the traditional retirement age. More than two out of five currently active physicians will be 65 or older within the next decade. And growing concerns about healthcare provider burnout suggest that these physicians will be more likely to retire early.
  • If underserved populations continue to experience the same healthcare use patterns, demand could rise by more than 70,000 to 145,500 doctors. 

Nurses too are feeling the effects of the pandemic. According to the International Council of Nurses (ICN), 20 percent of its National Nurses Associations (NNAs) reported an increased rate of nurses leaving the profession in 2020. Close to 90 percent of the NNAs are concerned that heavy workloads, insufficient staffing, burnout, and stress are key factors. 

What steps can skilled nursing facilities take to manage staffing shortages?

Human resources software firm Paycor has outlined some trends in long-term care facilities for 2022 to meet these challenges:

  1. With a rising population of seniors, long-term care facilities will need to find and implement new ways of recruiting and keeping existing staff is of the utmost importance. Increasing salaries, improving benefits, and embracing new technology will help secure top caregivers as well as administrative staff.
  2. The emotional and physical toll of burnout among caregivers is well-documented, so building a workplace culture that makes employees feel valued and supported to grow in their careers is vital. Other ways to support skilled nursing facility staff include benefits like flexible scheduling, childcare, concierge services, and letting staff maintain a healthy work-life balance.
  3. A focus on personalized care to boost both patient satisfaction and clinical outcomes will allow care facility residents to stay independent as long as possible, thus supporting their dignity and personal choices. This means that skilled nursing home staff—from top management down to nurses and other front-line workers—should be part of the decision-making process, leading to higher employee satisfaction and a sense of engagement and ownership in the level of care provided.
  4. Most adults over the age of 65 would prefer to remain in their own homes for as long as possible. Some long-term care facilities have responded to this trend by including home health aides, and hospice care.

Throughout the pandemic, the use of innovative technology such as telemedicine, connected voice, and artificial intelligence (AI) has created a new generation of voice-activated diagnostics tools and virtual patient assistants. Other tech tools like electronic health records (EHRs) and remote care are helping providers, as well as skilled nursing facility residents, stay connected, and these tools help clinicians better manage their time and stress levels.

The Allure Group, which operates six nursing homes across Manhattan and Brooklyn, has a goal of providing cutting-edge care and comfort for the growing needs of the aging Baby Boomer generation. Allure maintains a strong presence in the digital world, using EHRs and Vis a Vis Health technology, the latter of which enables clinicians to track the progress of discharged patients.

Every team member at an organization like Allure plays an important role. They must be valued, supported, and nurtured. This will continue to help boost retention and ensure the best possible outcomes.

Joel Landau, is founder and chairman of The Allure Group, a network of six New York City-based nursing homes.