Many post-acute care facilities have struggled to recruit and retain qualified staff post-pandemic, highlighting a need for solutions that improve patient care.
By Jenna Hughes
The post-acute care industry, which includes senior living, home health, and hospice, is currently facing significant staffing shortages. Fewer staff means an overall greater impact on care delivery and patient access within long-term care facilities. The post-acute market share currently consists of 63% nursing homes, 16% assisted living facilities, and 17% other communities, according to Bob Miller, executive vice president of Gericare Medical Supply, and Board Member of HIDA and IMCO. Each of these post-acute facility types are facing unprecedented shortages of staff.
Many factors play into post-acute care staffing shortages, including the lingering impacts of the COVID-19 pandemic, an aging U.S. population, burnout, higher rates of retirement in the industry, and an increased demand for care; all of which has left many patients and their families struggling to find adequate long-term care facilities to meet their needs.
Workforce shortages within post-acute care have made it more difficult for hospitals to discharge patients efficiently, keeping many in inpatient beds longer than medically necessary and crowding hospitals.
“Often, long-term care facilities must limit their number of admissions because they don’t have the staff to care for the current population of residents,” said Amy Stewart, chief nursing officer of the American Association of Post-Acute Care Nursing (AAPACN). “This leads to longer hospital stays, or, for some patients, being forced to receive at-home care, even though what they really need is long- or short-term care in a skilled nursing facility.”
The COVID-19 pandemic especially exacerbated staffing shortage issues for an already stretched-thin post-acute care industry. COVID-19 saw an influx of acutely sick patients in long-term care, and virus-related facility challenges resulted in hundreds of shuttered nursing homes across the U.S. Higher demand within the nation’s remaining facilities has caused patients in need of long-term care to face significant a reduction of available beds.
At least 774 nursing home facilities closed their doors between February 2020 and July 2024, according to the 2024 Access to Care report, displacing over 28,000 residents. There are now almost 60,000 fewer nursing home beds available since the pandemic began.
“The dangers of coming back to work after a deadly pandemic has made many staff rethink working in nursing homes. Compensation is also not adequate for many staff, and as a result, health care personnel are looking elsewhere and in different markets for employment,” said Miller. “Staffing mandates additionally put unrealistic expectations on nursing staff, hence, burnout has become a huge deal in the industry because overworked nurses can’t sustain their performance.”
Patient impact
Staffing shortages significantly impact the patient experience in long-term care facilities, with fewer staff members resulting in an overall poorer quality of care, increased facility re-admissions, and patient and family dissatisfaction.
“Workforce shortages are devastating to post-acute care facility residents because there is no consistency in their care,” said Miller. “These patients are used to the operations of their facility being standardized, with treatment such as bathing, medication, toileting, changing of undergarments, etc. being given on a routine basis. Workforce shortages impact this consistency and negatively affect patients.”
Already existing labor shortages prior to the COVID-19 pandemic worsened in the pandemic’s aftermath, and now, according to the Access to Care report, more than 66% of facilities are concerned that if their workforce challenges persist, they may also be forced to close their facility. In 2020, nearly 20% of nursing homes closed a unit or floor due to labor shortages.
In April 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This new rule set a minimum nurse staffing requirement, aiming to reduce the risk of residents receiving unsafe and low-quality care within long-term care facilities.
CMS set the staffing standard at 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities can use any combination of nursing staff to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.
“Facilities that cannot find or retain staff often find themselves having regulatory compliance challenges,” said Stewart. “This can lead to civil money penalties, and/or denial of payment. If the facility cannot get back in compliance, this may result in high costs which may eventually lead to closure of the facility. Many facilities have also closed units or wings, limited admissions or are using agency staff.”
The aging U.S. population is causing extra strain on the long-term care market. “The Baby Boomers generation is here, and the post-acute market is going to continue to grow. The population stands at 243 billion currently and is expected to grow at a 3% increase every year,” said Miller. “The elderly population is exploding, and more facilities, products, staff, and nursing personnel are going to be needed.”
Staffing shortages are especially detrimental for rural communities, where access to skilled nursing facilities is already scarce, and persistent closures have created the phenomenon known as ‘nursing home deserts,’ according to the Access to Care report, meaning that there are no long-term care options available at all for certain rural populations. Forty additional counties in the United States have become nursing home deserts since February 2020.
“Many rural facilities struggle to get staff and utilize agency staff,” said Stewart. “Using agency allows for care delivery but it can be costly, and the staff can come and go on a weekly basis. This makes continuity of care difficult in these communities.”
Maintaining consistent product inventory
Within distribution, maintaining consistent product inventory despite fluctuating staffing levels is an important component of patient well-being in long-term care facilities.
“The post-acute care industry has been changing drastically, and many physician’s assistants (PAs) are now helping in nursing homes. They do rounds, make changes, and are becoming the mainstay for residents in the homes, which is a good thing for the residents,” said Miller.
For distribution reps, however, ensuring that long-term care facilities’ product levels are correct can pose challenges, said Miller, especially when facing constantly shifting staffing levels.
“Newer staff members in long-term care facilities don’t always know the home well or may not have an idea of how much inventory they need to keep, so distribution reps must now look at the orders that are going into homes more frequently, so that they don’t run out of products,” said Miller. “This is very important to get product demand correct within these types of facilities.”
Gericare Medical Supply’s goals for meeting increasing demand within long-term care facilities going forward, said Miller, include solutions such as looking for products, like electronic medical record systems (EMR), that can help nurses during staffing shortages. “EMR products can transfer key patient information such as blood pressure, tests, and more automatically into charts, making product planning easier and more efficient for each patient.”
Staffing solutions
The problems created by staffing shortages within post-acute care are multifaceted, requiring a varied approach to improve care delivery nationwide. Embracing both technology and telehealth can optimize staff workloads and provide care to patients remotely, freeing up both staff time and pressure on physical facilities.
“AI is being used more often in the industry than ever before to solve issues and enhance solutions for residents,” said Miller. “Telemedicine is also being used in rural areas, so the resident is able to see and talk to their physician.”
Investing in the workforce by training and developing current staff, as well as improving workplace culture, may also enhance retention rates among long-term care staff. This entails providing staff with continuing education opportunities within or outside of the workplace, assisting staff with the cost of tuition for nursing school or post-grad education courses, and fostering supportive workplaces with attention to staff development.
Currently, nursing education has “limited openings for a two-year degree,” said Stewart. “A two-year degree could turn out nurses more quickly than the longer, four-year degree. However, because of long wait times to get into a two-year program, that isn’t happening. Two-year nursing programs could increase the number of nurses employed in the industry as a whole if colleges are able to take on more students.”
The growing aging population of the U.S. will soon present more open job opportunities for nursing graduates and unlimited growth potential for the future of the post-acute care workforce.
“The long-term care industry needs to become more attractive to new graduates,” said Stewart. “New graduates often do not realize the number of growth opportunities available in a long-term care career. Long-term care nurses can become certified in several clinical areas; and often, a nursing home or facility will provide, or pay for, this education for nurses.”
“There must be a career path established for those in healthcare who desire to enter into post-acute care,” said Miller. “These students must be informed early on of the details of the profession, including what they can attain if they follow this path, and understand what their salary might be if they accomplish this goal. The long-term care industry must show students, beginning at the high school level into college, that long-term care is an area of growth and potential.”