The workforce situation for aging services providers across the continuum is not improving. This was the top finding in a recent snap poll of LeadingAge members. Snap polls are quick, informal questions LeadingAge puts to our membership. This workforce snap poll was asked of our entire membership.

High level takeaways from the snap poll, conducted late June 2022, include:

• More than 60% of respondents reported that their workforce difficulties remain.
• The staffing shortage is severe in multiple settings across the continuum.
• The pipeline for potential workers has not gotten stronger as people leave the field.
• Nursing positions are especially difficult to fill.
• Almost all nursing homes count on agency staff to cover some percentage of shifts but one out of ten respondents rely on temporary staff for nearly half of all shifts.
• If staff leave, the most commonly cited reasons are seeking better pay or burnout.

These findings support the compelling need for an “all hands” approach to both communicating aging services workforce challenges to policy makers and finding an array of solutions. Unfilled vacancies, lack of domestic and international pipelines, and low wages and benefits have created the perfect storm—complicated and made worse by the pandemic.

What are the implications of staffing shortages?

Staffing shortages reduce access to care for vulnerable older adults and their families. Just when families need help the most, availability dwindles daily. Reports abound that individuals who need post-acute (after hospital) care are remaining longer than necessary in hospitals because there are no SNF or home health providers with enough staff to serve them.

Staffing challenges and expensive temporary solutions offered by staffing agencies have driven many providers to closure or to the brink of closure. In a recent survey of nursing homes and assisted living providers in Minnesota, half the respondents reported they have only enough resources to remain in business for one month or less. Similar findings were reported from Texas in a June 2022 survey. On the same surveys, half of Minnesota nursing homes say they are reducing capacity and 70% of Texas nursing homes are limiting admission—all due to not being able to recruit and retain qualified staff. Anecdotal evidence supports the notion that these are problems in every state.

It’s not getting any easier: “You fill one position and two more open up.”

As noted, nearly two-thirds of the LeadingAge members who responded to our snap poll said their staffing difficulties are not easing up. These providers report the top reasons people leave are they are seeking better pay (75%) and burnout (72%).

Domestic and international pipelines need to be stronger  to fill the need for aging services workers.

The challenge of finding qualified applicants—or any applicants—is more difficult than ever. Vacancies stay open, often with no applicants at all. “The few applicants we get are only looking to be paid for the two-week orientation, and then they never return. The loyal staff that we have are burnt out and desperately need help,” one provider said.

It’s not just nursing homes. The staff shortage is severe across the continuum of aging services.

The lack of applicants, high turnover, and burnout of aging services workers spans all aging services settings. As one member said, “while others are having more success in retaining and recruiting talent, our organization continues to barely tread water and is unable to get candidates much less hire them.”

• 93% of nursing home respondents say they have a significant (28%) or severe (65%) staffing crisis.
• 80% of assisted living respondents say they have a significant (45%) or severe (36%) staffing crisis.
• 86% of life plan community respondents say they have a significant (45%) or severe (41%) staffing crisis.
• More than half of affordable senior housing providers say they have a significant or severe staffing crisis.
• Shortages persist in home health and adult day as well.

The policy response: action needed on many fronts.

The snap poll findings are self-reported by an opportunity sample, but they draw a clear picture of the crisis. LeadingAge is pursuing an aggressive campaign, Aging Services Workforce Now!, to raise awareness of the urgency of the crisis and to drive policy makers to implement solutions. There are simply not enough staff to care for the growing aging population.

Our advocacy focuses on: permanently paying aging services workers a living wage; increasing incentives to retain and attract qualified staff; expanding training and advancement opportunities; building dependable international pipelines; and enacting meaningful, equitable long-term care financing system. Some highlights of LeadingAge’s workforce advocacy agenda are outlined below. These are just examples, by no means are they a complete list.

Congress could take steps right away to enact legislation that would:

• Create an aging services guest worker program to welcome qualified workers from overseas who want to do meaningful jobs in aging services organizations.
• Provide permanent wage subsidies to aging services workers.
• Impose limits and controls on price gouging by temporary staffing agencies.
• Expand training programs run by the HHS Health Resources Services Administration (HRSA) for nurses, nurse aides, and others.
• Extend the Temporary Nurse Aide program that started during the pandemic and enables more aides to work and receive on the job training.
• End the CNA training lockout that prohibits some nursing homes from operating training programs.

The Executive Branch does not need to wait for Congress. Some steps, such as the following, can be taken immediately.

• Recognize the enormity of the problem and establish a solutions-focused cross-government task group in the White House for an all-of-government response.
• Speed up Department of Labor processing time for prevailing wage determinations (this part of the immigration process should not take six months).
• Build on the multi-department Career Connect program to focus on jobs in aging services.
• Allow virtual embassy interviews, rather than insisting on face-to-face interviews for nurses applying for visas to come work in the US.

Inaction is not an option.

There is no “one size fits all” solution to this complex problem. Congress will need to take major steps to create new programs and fortify existing ones. Every department in the Executive Branch has a role to play. Providers can make some changes, but not without collaboration with and support from policy makers. This is a problem with tens or even hundreds of solutions, but as the population rapidly ages, we cannot do nothing.