The American Health Care Association (AHCA), the primary national trade association for the nursing home industry, reports that 94% of facilities responding to their recent survey report a shortage of staff and that nearly 75% report that staffing shortages have gotten worse since 2020. As proposed by AHCA and LeadingAge, the trade association of not-for-profit providers, in their jointly-released Care For Our Seniors Act, more reimbursement is needed. 81% of AHCA’s survey respondents agree that higher reimbursement would enable them to offer better salaries and benefits to their workers.
We have heard this industry message before, many, many times. It’s time for a different response from the multi-billion dollar nursing home industry, most of whose reimbursement comes from public dollars.
The Center has issued a new report that maintains that if facilities really want more staff, they must employ an appropriate number of permanent staff, pay all workers a living wage, and provide all workers with meaningful benefits, sufficient training, and a positive work environment. These recommendations are recognized by workers and nursing facilities alike as specific, straightforward ways to improve staffing levels and quality of care for nursing home residents.
The report describes the need for a living wage for all workers and contends that facilities already have sufficient reimbursement to pay staff well, if reimbursement were redirected from administration and profits to resident care. It cites multiple reports documenting that facilities’ related-party transactions and on-going practices divert money from resident care and are correlated with poorer resident outcomes. It also suggests known strategies for focusing reimbursement on care, including enactment of direct care ratios, which require facilities to spend designated portions of their reimbursement on care and services for residents and which limit the amounts that can be spent on profits and administration.
The report concludes that staffing at nursing facilities can and must be improved. Methods to strengthen staffing are well-known. The question is whether we have the will to make necessary changes.
The full report is available at: https://medicareadvocacy.org/wp-content/uploads/2021/08/Report-Staffing-Shortages-in-Nursing-Homes-07.2021.pdf
August 5, 2021 – T. Edelman
 AHCA, “Survey: 94 Percent of Nursing Homes Fact Staffing Shortages” (Press Release, Jun. 23, 2021), https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Survey-94-Percent-of-Nursing-Homes-Face-Staffing-Shortages.aspx. An executive summary of the survey, State of Nursing Home and Assisted Living Industry: Facing Workforce Challenges, is available at https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-June2020.pdf
 AHCA and LeadingAge, “Care for Our Seniors Act; Improving America’s Nursing Homes By Learning From Tragedy & Implementing Bold Solutions For The Future, https://www.ahcancal.org/Advocacy/Documents/Care%20for%20Our%20Seniors%20Act%20-%20Overview.pdf
 AHCA, “Survey: 94 Percent of Nursing Homes Fact Staffing Shortages” (Press Release, Jun. 23, 2021), https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Survey-94-Percent-of-Nursing-Homes-Face-Staffing-Shortages.aspx
 “Nursing Home Industry is Heavily Taxpayer-Subsidized” (CMA Special Report, Jul. 9, 2021), https://medicareadvocacy.org/wp-content/uploads/2021/07/Special-Report-SNF-Subsidies.pdf
 PHI, Federal Policy Priorities for the Direct Care Workforce, p. 4 (2021), citing “Workforce Data Center.” Accessed 6/8/2021. https://phinational.org/policy-research/workforce-data-center/. The report is accessed through a link at http://phinational.org/resource/federal-policy-priorities-for-the-direct-care-workforce/; Robyn I. Stone and Natasha Bryant, Feeling Valued Because They Are Valued; A Vision for Professionalizing the Caregiving Workforce in the Field of Long-Term Services and Supports, p. 3 (Jul. 2021), https://leadingage.org/sites/default/files/Workforce%20Vision%20Paper_FINAL.pdf. See “Reports Call for Changes for the Direct Care Workforce” (CMA Alert, Jul. 15, 2021), https://medicareadvocacy.org/reports-call-for-changes-for-the-direct-care-workforce/, identifying similarities in the strategies recommended in the reports.