By JULIE MINDA

When the nonprofit LeadingAge association conducted a poll of its member aging services providers in June, the results were decisive: an overwhelming majority are experiencing staffing shortages that will not self-correct. Attention must be paid.

Ministry continuum of care leaders say that it is very difficult to keep staff roles filled, and labor costs are rising unsustainably.

Benedictine Living Community — Shakopee, Minnesota, mailed this postcard in 2020 and 2021 to certified nursing assistants and nurses living within a 50-mile radius around Shakopee. Aging services providers across the U.S. report ongoing challenges recruiting and retaining nursing staff.

"Wage inflation and pool utilization are the issues," says Jerry Carley, president and chief executive of Benedictine. Pool staff refers to agency or travel staff hired through an outside company.

Nearly 600 LeadingAge members responded to the Workforce Informal Snap Poll. A significant or severe staffing shortage was reported by 93% of respondents from nursing homes; 80% of those representing assisted living said the same, as did 86% of those with life plan communities. Life plan communities offer multiple levels of care at one campus, aim to support healthy lifestyles and keep residents involved in the surrounding community.

A poll analysis by LeadingAge notes, "the pipeline for potential workers has not strengthened as people leave the field, with members reporting particular difficulty filling nursing positions."

Agency siphon
Allison Q. Salopeck, president and chief executive of Jennings in Garfield Heights, Ohio, says that, as in acute care, many nurses have left long-term care during the pandemic to work for health care staffing agencies that pay higher salaries.

Denise "D.G." Gloede is president of post-acute care for SSM Health. She says the burnout of pandemic-weary staff propelled the 2021 exodus.

The situation described by the ministry executives is consistent with the findings of the snap poll. More than 70% of respondents had said the top reasons staff were leaving were because of burnout and for better pay.

Jan Hamilton-Crawford, president and chief executive of Trinity Health Senior Communities, notes while the staffing shortages have been worst among certified and licensed clinical staff, resignations and a dearth of job applicants have impacted staffing throughout eldercare facilities.

Salopeck says the ongoing labor force shortages and the corresponding necessity to hire agency staff make it almost impossible to anticipate what labor costs will be and to plan for other vital operational details that are related to labor, such as resident census.

Reprieve
Gloede says staffing levels have been stabilizing this year, though they are not back to prepandemic levels.

She and the other executives are relieved that staff shortages have abated, but they remain concerned about the long term. Eldercare facilities are competing with the full continuum of health care facilities for staff, and it is difficult for them to offer the salaries that other sectors of health care can offer.

The LeadingAge survey found that nurse, licensed practical nurse and certified nurse assistant roles were the hardest positions for poll respondents to fill. Just over half of respondents said staff have departed their facilities with the intent to permanently leave the long-term care sector. Julie Trocchio, CHA senior director of community benefit and continuing care, says eldercare facilities also are having trouble retaining and replacing nursing directors and facility administrators.

Fixes
The ministry system executives say they are taking a variety of approaches to address the patient-facing workforce issue short term.

Gloede says SSM Health has been using technology to try to decrease its staff's workload, to free people up for resident care. It has been rolling out a standardized electronic medical record to make data gathering and use more efficient.

Hamilton-Crawford says Trinity Health Senior Communities is offering referral bonuses to staff who help recruit new employees.

Carley says Benedictine is exploring how best to work with the hospitals in communities with its continuing care campuses to ensure the health care employers are viewing the local labor market as an ecosystem and approaching hiring in a collaborative way. During the pandemic, some hospitals in Benedictine markets aggressively recruited nurses and poached them from long-term care providers. Then the hospitals had nowhere to discharge some patients, because the nursing homes that once admitted people for short-term rehab or long-term placement were not staffed to take new residents.

Hamilton-Crawford says the labor pool in communities where Trinity Health Senior Communities has eldercare campuses is one in a constellation of factors her division uses to make decisions about continuing existing business lines and adding new services.

The long game
Gloede says, "SSM Health eldercare facilities are working to make college students in clinical and nonclinical academic programs aware of the career opportunities in long-term care, including in administrative roles."

Salopeck adds that many students in clinical programs at colleges and universities have no desire to work in long-term care. She says this relates to a broader issue of how society negatively views nursing homes and disregards the elderly.

She says wonderful things happen every day in eldercare facilities, including the way that staff care for residents as individuals worthy of respect and compassion. She says it's a misperception that frail elderly are always safer and happier living independently. Many nursing home residents are at high risk for falls, have other mobility limitations and are incapable of performing some routine tasks of daily living.

"We need to change the narrative, we need to change how we talk about long-term care," Salopeck says.

Trocchio agrees, saying that ageism is real and society tends to deprioritize services for elderly people.

Trocchio adds that there are some for-profit providers that have gained a reputation for substandard care, and people have come to believe, wrongly, that there are no good nursing homes.

Hamilton-Crawford says Trinity Health Senior Communities is polishing how it presents itself to prospective staff and the broader community. She says a goal is to create an environment where staff feel valued and where they feel a sense of belonging. She says Trinity Health Senior Communities wants to foster workplaces where staff love the work they do.