How to solve the local nursing home staffing crisis

Sometimes those of us in the senior living industry think of our business challenges as unique, but this is frequently not the case. While we are seeing it right here in our community, the current nursing home staffing shortage is not unique to the Greater Rochester region — it’s being felt across the country.

According to the Bureau of Labor Statistics, nationally, between February 2020 and December 2022, the number of nursing home employees dropped from over 1.5 million to 1.3 million, indicating a loss of 210,000 jobs. The report also notes that the sector has not seen workforce levels like this since 1994.

This shortage is very much like the current housing crunch also affecting our entire nation. The housing supply isn’t sufficient to meet demand and therefore people are bidding up the price of existing structures. These price increases will slow in two situations: One is if more homes are built. The other is if prices get so high that fewer can make a purchase and just stop looking and bidding. If a public policy goal is to have more homeowners, then the answer is to make public policy decisions that facilitate construction.

The supply of nurses and nursing assistants is critically low in our region, just like housing. Currently, those of us trying to hire staff are coordinating various creative recruiting efforts, but mostly what we’re doing is raising wages and stealing staff from each other. This has been good for workers, but it’s had no effect on overall staffing levels. New candidates just aren’t entering the job market, even with much higher salaries being offered universally. One health care facility’s gain is another’s loss.

What we’re beginning to see occur, just like in housing, is that some facilities are being priced out of the market. Those service providers will close, exacerbating an already critical shortage of care options for those in need, especially in lower income brackets and already underserved areas. That doesn’t seem to be in the interest of public policy.

In my college economics classes, I learned that resources flow with capital. Or, said another way, money talks. However, even with a rather dramatic increase in health care wages, we don’t seem to be getting people off the sidelines and into the workforce.

Special Circumstances in the Nursing Home Industry

Although staffing issues currently exist in many industries, nursing home staffing problems are, in fact, unique in several important ways. The first is that the industry isn’t seen as attractive to job seekers. An analysis done in 2021 (looking at 2020 data) concluded that when using a broader definition of “being injured at work” — beyond illness and OSHA injury data — working in a nursing home in 2020 was the most dangerous job in America. The risks of working in a nursing home surpassed even logging and commercial fishing. High-risk jobs are typically highly paid, because to attract talent, employers have to compensate for the risk. But because of the not-for-profit nature of many nursing homes, the salaries aren’t commensurate with those of other high-risk jobs.

Jobs in nursing homes also aren’t looked at as cool, interesting or even exciting. Other high-risk jobs have reality shows dedicated to them, like “Ax Men” or “Deadliest Catch.” There aren’t any Netflix shows called “Chicago Nursing Home” or “Nursing Assistant Legends.” We’re proud to work in this industry, and the work is honorable. However, the perception is that while the work is fine, it gives you no reason to brag to your friends.

Finally, the nursing home industry faces one other very large competitive disadvantage: the ability to offer flexibility and remote work. It’s not possible for our staff members to decide to feed your elderly mom or dad when it fits their daily schedules, and they certainly can’t help someone from a remote location. I’ve read all kinds of great articles in HR industry publications about using flexibility to build your workforce, but that option isn’t available to us for most of our jobs.

Nursing Home Problems Are Everyone’s Problems

It would seem that the public policy interest here is to increase the supply of skilled workers, rather than watch the availability of nursing home beds continue to decline — which ultimately hurts the most vulnerable of our citizens. The current situation has the potential to turn into a significant problem for health care in general, as well. If nursing homes close, hospitals will fill with patients who need skilled nursing care. This will ultimately limit the supply of care for all people in every age group.

Possible Big-Picture Solutions

When we ask for support, most legislators are very kind, express empathy and often quote from the movie “Dances with Wolves”: “We must talk of this again.” So are there any solutions? I say yes, and they don’t require miracles.

One public policy action we could take is to offer free federal or state-funded education to people who are willing to pursue nursing or a related field of study. A model similar to military service could be used to forgive student debt if they work in the field for a specified number of years. This might be a wonderful opportunity for people struggling to find a financially rewarding career path, as well as others who don’t enjoy large college debt. Having more heath care workers will benefit the country, not just those receiving the benefit.

Another option we could pursue is a change in immigration rules for skilled health care workers. Current immigration policy permits many “skilled workers” to acquire a visa. Throughout history, immigration has been a critical part of helping close the gap in labor shortages. It would not be insurmountable to offer this route for nurses and nursing assistants in a similar manner as we already do for software engineers.

Something will probably happen on the housing front because everyone cares. In my limited experience, few people care much about nursing homes. I’m no better. I didn’t spend five minutes of my life thinking about nursing homes until I came to work in the industry. Maybe because hospitals use similar staff pools as nursing homes — and nursing home closures will ultimately critically affect heath care in general — something will happen. The public does seem to notice and have concerns about poor hospital staffing.

There are big ideas that can fix the nursing home staffing crisis. While I offered two, there are likely many others. We can do the right thing and take care of your mom and dad. We just need creative and brave people with policy-making responsibility to take the initiative.

Dean Moore is vice president of work/life at St. John’s, a full-service senior care provider with options that range from independent living to skilled nursing and hospice in Rochester, New York. He has been in the human resources industry for more than 30 years.