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Long-Term Care’s Employment Crisis

The COVID-19 pandemic continues to exacerbate the challenges for Texas’ long-term care industry.
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(Courtesy: iStock)

The $14.5 billion long-term care industry lags behind the employment relief that other industries have experienced in the last few months. Regulations, COVID-19 concerns, and limited admissions create an emotional strain for workers and result in a statewide crisis.

The employment crisis in long-term care is so vast that most facilities are resorting to staffing agencies. For many, it is the first time to do so and is not the preferred method for employment. Staffing agency employees can cost a facility upward of $45 an hour, around three times what the company usually pays. A study from the National Health Care Association and the National Center for Assisted Living found that 99 percent of nursing homes are experiencing a shortage and asking staff to work overtime and pick up extra shifts. Nearly 80 percent of nursing homes are concerned they will have to close due to shortages. 

“One day, we’re operating as we always had been and within the boundaries of what we knew. Then all of a sudden, everything changed, and we had to switch gears on a dime and try to figure out how to transition quickly,” says Danica McGuire, executive director of Ventana by Buckner Retirement Services.

The staffing agencies are not only a solution to the problem; they can also be a cause. “These staffing agencies try and recruit existing staff to work for them. It’s enticing because they offer better pay,” says George Linial, President & CEO of LeadingAge Texas, a non-profit association that advocates for long-term care communities, “It’s a vicious cycle that leads to the facility paying a huge amount for their employee costs.”

The pandemic is driving long-term care facilities to make difficult decisions while trying to fill positions. The pandemic helped long-term care companies realize that many staff took jobs in multiple facilities to make ends meet. But with the surge of cases in nursing homes came a restriction on the ability for employees to practice multiple facility care. “A lot of our members had to say. ‘You have a choice; you’ve got to decide where you want to work,’” says Linial.

The lack of childcare also created barriers for people to come to work. Linial says more flexibility is needed to allow workers to work around school and childcare concerns.

COVID-19 created a negative perception for long-term care providers as well. “In the beginning, we were asking people to come into harm’s way. Long-term care nursing was the second most dangerous profession in the country at one point during the pandemic. There was a lack of PPE and supplies, and everyone was caught off guard,” Linial says. “A lot of that has changed now with staff and resident vaccinations and proper PPE. It’s become a lot safer.”

The industry could use an image adjustment. “I think we need to change the perception of what it takes to work in the field. It’s a people taking care of people business, and it takes a special kind of person to work in that field,” Linial says. “I don’t think that’s stressed enough in terms of what a great field it is to work in is because it’s an emotional connection you get with other people; you don’t see that in every job. But long-term care is exactly what it is: long-term. You get to know people and establish pretty significant relationships.”

One of Buckner’s newest long-term care communities, Dallas’ Ventana, opened months before the pandemic. McGuire says the financial setbacks of the pandemic are only compounded by the staffing and limiting admissions, adding to the stress and challenge of overcoming this employment crisis while running a relatively new community. “That’s not unique, but is an even greater challenge for Ventana specifically.”

So how does the industry solve these problems? Better benefits, new PTO policies, staff appreciation, and improving care may help, McGuire says. Asking questions about how best to support and celebrate employees will be necessary. “It challenged us to take a step back and figure out how to celebrate the milestones that we were hitting how to celebrate the things that weren’t all gloom and doom,” McGuire says. “How do we promote mental health and insert a little bit of fun?”

LeadingAge stays busy advocating for legislative changes related to long-term care funding, improving Medicaid rates, modernizing and developing reasonable care regulations, and education.

The pandemic and the stigma connected to the industry have been challenging to overcome, but one solution is awareness of the problem and potential solutions. “Long-term care is often forgotten. We need people to get the word out.”

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