Everyone has been feeling the nursing shortage, and now the Biden administration has tightened staffing rules, and that order will become a harbinger of more skilled nursing facility crises and closings. Maybe it’s less that “nobody wants to work” and more “nobody wants to work in bad conditions for low wages.”
The shortage of nurses goes back decades, but COVID-19 pushed it to a crisis. Over 50% of the nurses currently working are over 50; expect early retirements as the workload and expectations increase. The shortage is not expected to lighten up any time soon. In 2021, in the middle of a global pandemic, nursing schools in the US turned away over 91,000 applicants due to a lack of faculty, education space, and resources.
As a means of improving care and safety in SNFs, the Biden administration is increasing safety standards, increasing staffing and increasing penalties for SNFs that are poor performers. Grants will allegedly become available for nursing expansion and education.
Increasing staffing seems like a great idea. Who wouldn’t want a 1:5 staffing ratio, or even 1:1? But where does our administration expect us to find the staff and the funds? Less needle-in-a-haystack, more unicorn-in-a-black-hole.
In an industry that’s struggling to care for the oldest and sickest population and paying the very least possible to those who perform the care, how can even the big-chain SNFs hope to meet the staffing requirement? The caregivers we will need to hire just don’t exist. One union organizer hopes to make the jobs better and pay better through unionizing, but that will cost the worker and the employer. And if the caregivers don’t exist, there’s no one to unionize.
President Biden signed an Executive Order last month that effectively punishes an industry where half of all caregivers leave their jobs every year. Around 70% of a SNF’s income goes to staff wages and benefits. The rest goes to food, utilities, etc. The grants that are promised may not be enough, or soon enough, to be effective.
How are we helping our staff to want to stay? How are we showing staff support?
We keep hearing that “nobody wants to work anymore.” If your job provided poverty-level pay, poor working conditions, little regard for family priorities, and unrealistic expectations for the workload, would you want to keep it?
A friend who works in SNF rehab part-time recently gave her notice. She got no PTO, was not allowed to call off if her child was sick, was required to work on a Saturday if she called off during the week, and was told that her documentation should be performed “off the clock” in order to meet her unrealistic productivity standard. What a combination of disregard, arrogance, federal-law violation, and resignation-provoking incidents to consider. During her four-week notice, they still wouldn’t allow a day off. Which, of course, she took anyway.
We don’t yet know what the staffing level requirement will be, but we do know that this will trigger more SNF closings. Without support from state and federal governments to provide funds and assistance for more staffing, and without education for aspiring nurses and caregivers, this shortage is insurmountable. While the new Executive Order is aspirational and sounds great on paper, we need to determine how to procure and retain the caregivers that will be required to meet the law.
One way to start is to make the worker eager to be part of a team that understands their priorities, and you will become the employer of choice. Word of mouth from happy employees may be the best marketing you have.
Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD, is the regional director of therapy operations at Diversified Health Partners in Ohio.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
