Staffing concerns are front and center in the daily lives of aging services providers, according to a LeadingAge pulse survey conducted in the last week of September.  Using an opportunity sample, the survey helps to illustrate what the workforce crisis looks like on the ground for LeadingAge members, on a variety of issues. A snapshot of survey results is available here.

The survey results are also useful in our advocacy with members of Congress and the Administration. This is particularly important given the historic funding allocations that are currently being negotiated in the Congressional Infrastructure Package that make significant investments to support older adults and LeadingAge members. The next step is to bring these committee bills to the House floor. The proposals under consideration provide relief for several areas that are fueling the aging services national workforce crisis. They would: add funding to increase Medicaid reimbursement for HCBS, establish strategies to strengthen recruitment of aging services workforce, and provide opportunities to expand training directed to our nation’s direct care workers.

LeadingAge Staffing Survey Results:

Survey Respondents

More than 70% of the survey respondents offered nursing home services, 49% offered assisted living, and 35% offered memory care services. Additionally, 16% offered Affordable Senior Housing, 14% were home and community-based services (HCBS) providers, and 13% offered home health and 9% hospice services.  As is increasingly typical in aging services, many providers offer multiple services (so these numbers total more than 100%).

Staff Vacancies

The majority of the respondents indicated significant staff vacancies. Several respondents shared they need to hire at least 50% more staff to become fully staffed. In one case, a member that has 35 full-time positions when fully staffed, currently has 20 vacancies. Another has 102 full-time positions when fully staffed and they have 49 vacancies.

In many cases administrative and managerial staff are filling in to cover for staff vacancies. On-call staff are also filling positions, or existing staff work extra hours.

Temporary Staffing Agencies

To assist with filling staff vacancies, the majority of LeadingAge members have relied more heavily on temporary or agency staff, especially since the pandemic. Fifty-seven percent of survey respondents indicated they are filling vacant positions with temporary or agency staff. One nursing home respondent shared 75% of their shifts were filled with agency staff.

Several respondents commented they are unable to use temporary or agency staff, because agencies do not have available staff, or providers can’t get contracts at a reasonable price. It was also noted that agency staff are also sadly not dependable; attendance issues are much more common and agency staff might not show up.

Staff Recruitment

The survey responses reflected significant shortages for in demand workers who provide high-quality long-term services and supports (LTSS) for older adults. Certified Nurse Assistants (CNAs) were the most difficult for 52% of the respondents to recruit; 24% had difficulty attracting Registered Nurses; and 9% had difficulty hiring Licensed Practical Nurses.

Employee Retention

Retention is also one of the top operational challenges for LeadingAge members. When asked about the reasons staff members are leaving your organization, an overwhelming 75% of the responses shared “seeking better pay” as a reason. Anecdotally, many LeadingAge providers say it is hard to compete with retail and food service businesses in the area, when most aging services providers are dependent on public programs and must tie wages to reimbursement.  

There were 62% of the respondents who reported “avoidance of taking the vaccine” as the reason staff members were leaving the organization, though it must be noted that providers that have implemented their own mandates report that far fewer staff actually leave compared to those who talk about it when they hear about mandates. When the CMS Interim Final Rule on vaccine mandates for health care workers is issued later in October, we will begin to get a better idea about the relative role of vaccine mandates in staff departures. Additionally, 42% percent of the respondents said staff are seeking better schedule or hours.

Respondents also provided additional comments on why staff members are leaving their organization. Some of the most frequently referenced comments included:

• Burn out or stress associated with the pandemic;
• Fear of COVID-19
• Seeking employment opportunities that offer higher pay, which includes temporary staffing agencies and hospitals;
• Seeking non-medical jobs; and
• Unemployment benefits pay better

Inability to Admit Residents and Consumers

When asked whether respondents were unable to admit residents or consumers due to staffing shortages, 42% indicated they are experiencing significant challenges. Additionally, 25% of the respondents had challenges so significant that they had to shut down units or building or neighborhoods due to staffing shortages.