Nursing home staffing rebounds from COVID levels
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Nursing home staffing levels have mostly bounced back to pre-pandemic levels after cratering during the health emergency.
Why it matters: The nursing home industry pointed to staffing shortages and difficulty hiring new workers in its successful fight against the Biden administration's first-ever minimum staffing requirements.
- But aging baby boomers and Trump administration immigration policies could soon reverse the tide and leave the industry dealing with more demand for care than it can handle.
State of play: Nursing and residential care facilities across the country employed about 3.49 million people as of May, according to the preliminary federal data, up from 2.96 million at the industry's lowest point in January 2022.
- More granular federal data shows that among nursing homes specifically there are only 1,400 fewer staff employed today than in February 2020.
- Nursing homes lost more staff during the pandemic than any other health sector, and staffing shortages also contributed to the loss of available beds between 2019 and 2024.
Zoom in: The industry has doubled down on developing incentive programs and career ladders to attract people to long-term care work.
- "I'm super excited when I go around the country and see the improvement not only on recruitment but on retention," said Clif Porter, CEO of the nursing home trade group American Health Care Association/National Center for Assisted Living.
Case in point: Arkansas' state nursing home association has opened its own accredited educational programs for nursing home staff to earn higher certifications and degrees that are tuition-free. It's allowing enrollees to work while attending school.
- "I have heard from a lot of administrators ... that this is giving them hope for the future," said Rachel Bunch, executive director at the Arkansas Health Care Association.
The intrigue: AI's effects on the labor market may also be boosting interest in nursing home jobs. Algorithms can't replace a live caregiver lifting a patient and moving them from the bed to the shower, Porter told Axios.
Yes, but: The rebound in staffing doesn't justify a national minimum workforce requirement like the Biden administration wanted, AHCA/NCAL staff told Axios.
- Such mandates didn't recognize local workforce variations or shifting demographics that will increase demand for care, they said. The association is focused on building a stronger workforce, which it says is more meaningful.
- There's also uncertainty from the White House's immigration crackdown, which could disproportionately affect an industry in which 1 in 5 workers is an immigrant.
The other side: The staffing rules — which were tossed by a federal court last year — allowed for exceptions in particularly tight labor markets, said David Grabowski, a health care policy professor at Harvard Medical School.
- "It wasn't a perfect rule, but I do think having that floor would have really helped here, in terms of guarding against these really low-staff places," he said.
Reality check: The number of adults aged 80 and older is projected to double between 2025 and 2045, as the proportion of working-age adults declines.
- Nursing shortages across the entire U.S. health care sector are expected through 2038, according to a federal analysis.
The bottom line: The nursing home labor reprieve could be short-lived.
- Staffing levels today are better than they were during the pandemic, "but I still don't think we're quite where we need to be," Grabowski said.
