An unprecedented workforce shortage spurred by the COVID-19 pandemic is continuing to severely impact nursing homes around the United States, and Colorado is no exception.
Between February 2020 and December 2022, nursing homes lost 210,000 jobs, according to an analysis of Bureau of Labor Statistics year-end data released by the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) on Thursday.
The last time the number of nursing home employees was this low was 1994, according to the report.
At the current job growth rate, these facilities won't reach pre-pandemic levels until 2027 — slower than a previous model that estimated a recovery by 2026.
Filling open positions hasn't been an easy process.
About 96% of nursing homes have had trouble hiring, according to a AHCA survey of 500 providers in the country published on Jan. 10. About half of them said their workforce situation has been on the decline since May 2022. This continues to be an issue, despite incentives like increased wages and bonuses.
The survey also found the following:
- 84% of nursing home providers are currently facing moderate to high levels of staffing shortages
- 96% of nursing home providers find difficulty in hiring staff
- 97% of nursing home providers said the lack of interested or qualified candidates is a major obstacle to hiring new staff
- 78% of nursing home providers have hired temporary agency staff to adjust for shortages
- More than nine out of 10 nursing home providers increased wages and offered bonuses to try to recruit and retain staff
- 54% of nursing home providers say they are having to turn away prospective residents
- 67% of nursing home providers are concerned their facility may have to close due to the workforce challenges
- 52% of nursing home providers say they may not be able to continue operating for more than a year at the current pace
Out of any health care sector, nursing home providers have seen the worst job loss and continue to struggle as most other industries bounce back, the report found. It has led to some facilities limiting resident admissions or, in some cases, close their doors for good.
“The data doesn’t lie," said Mark Parkinson, president and CEO of AHCA/NCAL. "This is not just an exaggerated call for help, and this labor crisis will not go away on its own or through government enforcement. Our nursing homes are struggling to recruit caregivers, and if we do not get meaningful assistance soon, then the consequence will be hundreds of thousands of seniors displaced."
This includes financial support because many facilities have extremely tight budgets since Medicaid reimbursements rates often fall below the actual costs of care, the Jan. 19 report found. Add the increasing labor costs and inflation to that and there are even fewer resources to help — and hire — staff.
Colorado is seeing evidence of this playing out. Residents whose Medicaid benefits pay for their stays at assisted living facilities and nursing homes are receiving troubling news: Several facilities throughout the Denver metro area are either reducing their number of Medicaid residents, cutting out Medicaid altogether or shutting down entirely.
Colorado has about 400 assisted living communities and 64% of them are Medicaid-certified. About a quarter of residents are reliant on Medicaid for their long-term care.
Nicole Schiavone, president of the Colorado Assisted Living Association, explained that a big issue is the reimbursement rate these facilities receive from Medicaid. Residents who are paying privately often pay more than $2,000 more per month than the center gets for Medicaid residents over the same period, she said.
"For those facilities that are eliminating Medicaid as a payer source and telling residents they'll need to relocate, we have Case Management Agencies and our Regional Accountable Entities who are there to help members find new facilities," said Marc Williams, spokesperson for Colorado's Department of Health Care Policy and Financing. "The challenge is often finding a place who can accept them near their family or loved ones."
People who are stuck in this position in Colorado are encouraged to contact the Colorado Department of Health Care Policy and Finance, which is helping with this transition. That department's email is firstname.lastname@example.org.
At the federal level, the Biden administration is considering implementing a federal staffing minimum at nursing homes, which the AHCA and NCAL claimed "will only worsen the crisis."
In a statement from Feb. 28, 2022, the Biden administration said "establishing a minimum staffing level ensures that all nursing home residents are provided safe, quality care, and that workers have the support they need to provide high-quality care. Nursing homes will be held accountable if they fail to meet this standard." This could include a minimum requirement of 4.1 staffing hours per day for each resident.
Deb Emerson, principal at the accounting and consulting firm CLA (CliftonLarsonAllen LLP), which the AHCA uses, said in December that this additional burden — with no funding — will increase the number of facilities that are working in negative margins.
“Although there have been improvements in workforce availability in some areas of the country, nationally, nursing homes are still challenged to find the appropriate workforce," Emerson said. "If nursing homes are unable to increase their workforce, hundreds of thousands of residents could be impacted by census reductions.”
In mid-December, CLA finished an updated report that was released by the AHCA describing the need for more funding for workers to meet that potential nursing home staffing minimum mandate outlined by Biden.
"Due to increasing labor costs and pervasive workforce shortages nationwide, CLA now estimates more than 191,000 nurses and nurse’s aides are needed at the annual cost of $11.3 billion in order for nursing homes to meet a staffing minimum of 4.1 hours per resident day," the report reads about the proposal from the Biden administration.
This is an increase from July 2022, when the CLA estimated that an additional 187,000 caregivers an annual cost of $10 billion were required.
The report also found that 94% of the country's nursing homes would not be able to comply with the potential 4.1 hours per resident day staffing minimum.
By the CLA's estimates, about 450,000 people could be at risk of displacement if the facilities are unable to increase their staff to meet the Biden administration's proposed staffing minimum.
“Nursing homes have been doing everything they can to recruit and retain staff — including increasing wages — but it has not been enough to stem the tide," Parkinson said. "If Washington wants to increase staffing in nursing homes, then they need to put their money where their mouth is. Otherwise, we’ll fail to address the underlying issue here, and our residents will have fewer long-term care options.”
This issue will continue to grow in the United States and Colorado as the 65+ population grows.
As of December, Colorado is second only to Alaska in the U.S. for the fastest growing 65+ population. Over the past decade, that group in Colorado has grown by more than 317,000 to more than 800,000 people.
Between 2010 and 2020, the 65-74 age range was the quickest-growing demographic in the state. In the next decade, it will be the 75-84 age range. The number of people entering the 65+ range, meanwhile, is expected to slow slightly.
Overall, Colorado still has the sixth-lowest number of 65+ people compared to other states.