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Brett Arends’s ROI: Nobody knows who is going to staff America’s nursing homes


Nursing home operators say they are currently unable to fill 130,000 staff vacancies—a number equivalent to the population of Dayton, Ohio.

“This is an unprecedented situation,” says Mark Parkinson, the chief executive of the American Health Care Association/ National Center for Assisted Living. “It’s impossible to exaggerate the challenges faced in providing care, due to the inability to hire workers.” This is, he says, “an unprecedented worker crisis.”

Read: ‘Nursing homes in America are broken.’ But one coalition aims to turn ideas for vital nursing home fixes into reality.

And this isn’t like the restaurant industry, where if there aren’t enough staff the place closes Mondays and Tuesdays. In nursing homes, as well as assisted living facilities, the need never goes away. Some 1.3 million of America’s most vulnerable elderly people are already in skilled nursing facilities. More elderly people need care every day. (And if you’ve made it to middle age, by the way, your odds of ending up in one yourself is more than 50%.)

Too few staff mean some patients can’t get rooms at all. It means others risk neglect, injury, or worse.

“Without staff, there is no care,” says Katie Smith Sloan, CEO of LeadingAge, which represents nonprofit nursing homes. It’s just impossible.” There is, she says, “a dire workforce shortage.” Nursing homes are turning away applicants. Some are closing. The occupancy rates remain way below the levels seen back in 2019.

Meanwhile, people who should be receiving care in homes are stuck in hospitals. “People are bunking in hospitals,” says Smith Sloan. “This is not a good system we have at the moment—it is so broken.”

The problem is that although the pandemic has made matters much, much worse, they were already bad to begin with. Experts say the industry has been struggling for years—even decades—to attract enough staff.

“The staffing problem is not a new problem,” says Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group for care residents. “Nursing homes have not had enough staff for decades.”

Among the reasons for the staffing crisis? Low pay, few benefits, and difficulty getting training, she says. Turnover in the industry may be as high as 100%, she says.

Hands-on certified nursing assistants, who do most of the work, may be earning less than $15 an hour.

“The residents are not getting the care that they need when there aren’t enough staff,” she says.

Meanwhile the Biden administration is poised to make a tough challenge even tougher. This spring it is expected to announce new, mandated minimum staffing levels that raise the number of staff homes need even higher.

It may be no coincidence that the industry’s trade lobby got its own story out first.

The industry says that if they can’t fill the vacancies they have now, what chance would they have to fill even more vacancies demanded by the administration?

They may have a point, but Smetanka says “it’s not an either-or situation.” Staff levels need to be higher, because that’s key to getting better care. But there also has to be a concerted drive, led from the federal level, to solve the underlying staffing crisis. The staff need to be better paid, better treated and better trained.

As Robert Reich, the liberal economist, says in his latest Substack column:

“There is no labor shortage. There is, however, a shortage of jobs paying sufficient wages to attract workers to fill job openings. If employers want more workers, they should pay them more.”

Meanwhile California-based Carole Herman, founder of FATE (a nonprofit that fights nursing home abuses) and a long-term critic of the industry, warns that many in the industry are responding to the staffing crisis by cutting corners. 

“Turning patients away? I don’t know of anybody doing that,” she says. Instead, she says, more than 200 California nursing home operators have gotten legal waivers from the state allowing them to operate below minimum staffing levels. Last year the figure was 150. “They’re bringing all these people in and they can’t take care of them because they don’t have enough staff,” she says.

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