If We Build It, Caregivers Will Come

This week we celebrate “Careers in Aging Week”—a national observance honoring the many career paths in the long term care profession.

You hear so many stories of certified nursing assistants (CNAs) who became nurses, who then became directors of nursing, and onward. The same was true for me. I started as a CNA and eventually became the administrator of a nursing home in my home state of Maine.

Building a career in long term care can be personally and professionally rewarding, but how do we get more job seekers to want to enter our field in the first place? This is the surmountable challenge facing providers today, as we grapple with a historic staffing shortage exacerbated by the COVID-19 pandemic. According to data from the Bureau of Labor and Statistics, long term care facilities have lost more than 400,000 employees over the course of the pandemic—more than any other health care industry. Meanwhile, staff vacancies at many facilities sit open for months, even a year, and applicants are limited as many job seekers are now preferring work from home opportunities.

We all agree that nursing homes and other long term care facilities need more staff. The difference of opinion is how we get there. Some argue that nursing homes need more staffing mandates to ensure facilities have enough caregivers. Providers will tell you their reality—they can’t find more staff and are struggling retaining the staff they have due to a number of forces driving caregivers away from long term care. Focusing solely on more mandates and punishing providers with more citations and fines does not help the residents, fails to address the underlying issues, and takes away precious resources needed to recruit caregivers. And ultimately, continuing on this enforcement trajectory will mean facilities having to further reduce the number of residents they can serve or close their facilities altogether. Too many already have, including in my home state of Maine.

I want to be clear, the long term care profession supports accountability to ensure residents have the caregivers they need, but we cannot regulate our way out of this labor crisis. And no one silver bullet will fix it either. This is why in our reform agenda, the Care For Our Seniors Act, the American Health Care Association (AHCA) developed a comprehensive set of workforce solutions that policymakers should implement, along with meaningful funding, to tackle this crisis from all angles. We need to develop programs that help recruit new caregivers, retain current ones, and rebuild our training infrastructure.

First, we need to recruit new caregivers to the field, and that includes incentive programs that make the everyday lives of caregivers a little easier, like affordable housing, childcare assistance, tax credits, and loan forgiveness for new graduates who work in long term care. We are also long overdue for common-sense immigration reform to expand opportunities for individuals around the world to come serve our seniors here in the United States.

Second, AHCA believes there needs to be a comprehensive approach to staffing beyond ratios—staff training and experience matters. Facilities with high staff retention can help caregivers perform responsibilities more effectively, and they know the residents intimately and can better anticipate their needs. Therefore, staff retention is key to addressing the labor crisis and continuously improving care. Our plan proposes helping to retain current caregivers by providing career ladder and mentoring programs as well as grants to pay for ongoing training. Meanwhile, we must ensure caregivers feel valued and appreciated, especially given the burnout we’re seeing due to COVID. So, empowering staff, measuring staff satisfaction, and being responsive to staff needs are tactics providers can take to improve the workplace culture on their own. In addition, regulators should examine the unintended consequences of punitive enforcement approaches that are driving valuable caregivers away from the field.

Next, we need the infrastructure to train potential caregivers through higher learning institutions. Waiting lists for nursing schools because of a lack of teachers is unacceptable. Federal policymakers should offer direct incentives to states that invest in nursing education programs as well as to universities that have graduates work in long term care for two years or more. We should also establish formal partnerships between nursing homes and universities through grants to provide tuition-paid scholarships to nursing students who plan to work in long term care. Embracing innovative models that encourage more entry-level, non-clinical positions—like the temporary nurse aide or universal worker roles we’ve seen during the pandemic—can help attract a new force of caregivers and is a key opportunity for the future.

At the heart of these workforce proposals is offering better pay and benefits to our frontline heroes, something nursing homes cannot do on their own. With most residents relying on Medicaid and the program’s chronic underfunding, long term care providers are often out competed for workers by hospitals and other health care and private industries. Policymakers must fully fund Medicaid and provide sustainable resources alongside new staffing policies, so that providers can enhance investments in retaining their staff and recruiting additional caregivers.

Meanwhile, we must learn from this pandemic and follow the evidence on what will truly improve care for residents. That’s why in the Care For Our Seniors Act, AHCA proposes having a 24-hour registered nurse (RN) and enhancing the role of infection preventionists in nursing homes, as long as these increasing requirements are fully funded by the government and the availability of workers exists to meet the requirements.

Lawmakers should be working hand in hand with nursing home providers to implement this multi-pronged approach to build back our workforce. Unfunded government mandates will only make matters worse. We must address the negative misconceptions around long term care and barriers to offering frontline caregivers the compensation they deserve. Investing in childcare, affordable housing, tuition, loan forgiveness and expanded nursing school programs will encourage individuals looking to join this rewarding field.

Addressing this long term care labor crisis requires comprehensive precision. Pinpointing where the challenges truly lie and applying carefully thought-out solutions is critical. The Care For Our Seniors Act does this. AHCA looks forward to working with lawmakers to ensure every nursing home and assisted living community has the hardworking, dedicated employees they need, so that our nation’s most vulnerable receive the care they deserve.  We cannot do it alone, but we sure can do it together.

Holly Harmon, RN, Senior Vice President of Quality, Regulatory and Clinical Services, for the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit www.ahcancal.org or www.ncal.org.

Provider Magazine

Holly Harmon

April 22, 2022