Staffing in nursing homes has long been a critical concern, but the situation is beginning to show signs of improvement. As the industry faces ongoing shifts, particularly with the new federal staffing mandate, it's essential to understand the current landscape and the efforts being made to address these challenges.
The Evolving Crisis in Staffing in Nursing Homes
As we approach the end of the year, some nursing home operators report that the severe staffing shortages of recent years are easing. However, the situation varies depending on factors like the size of the chain and geographic location.
Laurel Lingle, VP of Talent Acquisition at Majestic Care, shares a hopeful outlook: "There are always going to be fires to put out. You will lose somebody, and you're backfilling a position. But I think it's really calmed down."
Despite these improvements, operators remain cautious, especially with the impending staffing mandate from the Centers for Medicare & Medicaid Services (CMS), which will require significant changes in staffing levels.
Understanding the CMS Staffing Mandate
In April 2024, CMS introduced a staffing mandate that requires nursing homes to provide a minimum of 3.48 hours per resident per day (HPRD) of total staffing. This includes specific allocations for registered nurses (RNs) and nurse aides, as well as a 24/7 RN requirement. This new regulation has sparked widespread concern among industry leaders, with some labeling it an "extinction event" due to its potential to exacerbate existing operational challenges.
While the broader healthcare sector has mostly recovered from the staffing shortages caused by the COVID-19 pandemic, the nursing home industry still lags. Nonetheless, providers are beginning to catch up by implementing unique strategies, improving pay and benefits, and reducing reliance on temporary staffing agencies.
Recruitment Strategies: A Shift Toward Stability
Many operators have made significant strides in recruiting and retaining staff, which is essential for complying with the CMS mandate. For example, Diversicare Healthcare Services has been successful in reducing its reliance on staffing agencies. CEO Steve Nee highlights the progress: "We have been 100% agency-free in all of our buildings for over a year now. We are all about recruiting efforts, attracting top talent, and then also closing that back door and keeping them here."
Diversicare's success is mainly due to its emphasis on employee well-being and professional development. The company has invested heavily in its workforce, not just through wage adjustments but also by creating opportunities for career advancement and leadership development.
Majestic Care has also seen success through its internal staffing agency, which was launched in 2021. This initiative offers full-time employment with flexible hours and full benefits, which has significantly reduced their dependence on external agencies.
Retention Efforts: Building a Dedicated Workforce
Retention is just as crucial as recruitment in ensuring a stable workforce. Many nursing homes are increasing their investments in training and professional development. For instance, the PACS Group has implemented centralized recruiting initiatives and career ladder programs to help nurses enhance their skills and advance in their careers.
Programs like Administrators-in-Training (AIT) also play a vital role in reducing turnover among leadership positions, which is crucial for maintaining stability across facilities. PACS Group's AIT program, for example, aims to provide tailored training experiences that balance federal and state requirements with individual needs.
Challenges Persist in Rural Areas
Despite these positive trends, many rural nursing homes continue to struggle with severe staffing shortages. Kimberly Green, COO of Diakonos Group, describes the situation in rural Oklahoma as "dire and stubborn." Even after transforming a facility into a specialized care center, attracting sufficient staff has been a challenge, mainly due to the non-competitive salaries and less appealing rural locations.
According to a report by the American Health Care Association (AHCA), 774 nursing homes have closed since February 2020, displacing over 28,000 residents. This stark reality underscores the urgent need for innovative solutions to the nursing home staffing crisis.
Conclusion
The nursing home industry is at a critical juncture. While some progress has been made in addressing staffing challenges, particularly in urban and more extensive facilities, rural areas continue to face significant hurdles. With the CMS staffing mandate looming, the pressure on nursing homes to recruit and retain skilled workers is more intense than ever.
Moving forward, the industry must continue to innovate and invest in its workforce to meet these challenges head-on. Subsequent articles in this series will delve deeper into specific strategies, such as the AIT programs, frontline worker pipelines, and efforts to expand the labor pool for nurse aides.
By understanding the current state of the workforce and exploring new approaches, nursing home operators can better navigate the complexities of staffing and ultimately improve the quality of care for their residents.
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