AHCA Survey - State of the Nursing Home Industry: Survey of 425 nursing home providers highlights persistent staffing and economic crisis

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released a survey of more than 400 nursing home providers from across the U.S. highlighting that the sector continues to face a serious workforce crisis. The lack of interested and qualified caregivers is forcing more than half of nursing homes to turn away new patients, and more than one-quarter have downsized their facility or closed completely. The survey also underscores how an unfunded, federal staffing mandate will be impossible for nursing homes to meet given the current labor market conditions.
Key workforce findings include:
  • One-third of nursing homes say their workforce situation has worsened since the end of 2022.
  • Approximately 77 percent of facilities face moderate to high level staffing shortages that require hiring agency staff or staff overtime to cover shifts.
  • 72 percent of facilities are very or somewhat concerned that they will have to close their facility because of persistent workforce challenges.
  • In order to continue providing high-quality care, 98 percent of providers have had to ask current staff to work overtime or extra shifts, 75 percent have had to hire expensive temporary agency staff, and more than half have had to limit new admissions due to staffing shortages.
  • The biggest obstacles for providers in recruiting new staff are their current financial situations and lack of interested or qualified candidates.
Access to Care Concerns
Respondents noted how the workforce shortage is impacting their ability to serve seniors and individuals with disabilities in their local communities:
  • More than one-fourth of nursing homes have had to close a unit, wing, floor or entire facility.
  • 55 percent of facilities are having to turn away prospective residents or patients.
  • 48 percent of nursing homes have a waiting list for prospective residents/patients of at least a few days.
  • 21 percent of facilities are downsizing the number of beds/units they can offer because of staffing shortages.
In the midst of this persistent labor crisis, the Biden Administration is expected to announce a federal staffing requirement. The survey also found that 96 percent of facilities are somewhat or very concerned about meeting a federal staffing mandate, with 63 percent of facilities saying their biggest concern with a potential federal minimum staffing requirement is finding staff to meet the requirement.
Providers are actively trying to recruit staff, with 90 percent of providers increasing wages and 85 percent offering bonuses. Unfortunately, despite efforts to hire more workers, 95 percent of providers say it is somewhat or very difficult to recruit new staff. A staffing requirement will be impossible to meet when nursing homes are already struggling to find applicants.
With the end of the COVID-19 Public Health Emergency (PHE) and its corresponding financial aid, nursing homes also have deep financial concerns. Eighty-six percent of facilities are concerned about the loss of financial aid from either enhanced Medicaid Federal Medical Assistance Percentage (FMAP), American Rescue Plan Act funding or other public assistance. More than half of providers say they are currently operating at a loss or negative total margin, and 45 percent say they cannot sustain operations for more than a year at the current pace.
“Every sector is dealing with a labor shortage right now, but for long term care, this crisis is historic, persistent, and unsustainable,” said Mark Parkinson, president and CEO of AHCA/NCAL. “Nursing homes continue to do everything they can to recruit and retain staff, including offering increased wages and bonuses, but we still can't find workers. We cannot solve this crisis alone.”
“We need Congress to invest in long term care and make it possible to build a robust workforce. Simply put, the Biden Administration's expected staffing mandate will be impossible for facilities to meet without meaningful resources and recruitment programs,” continued Parkinson. “We urge policymakers to instead focus on comprehensive solutions, such as the ones AHCA laid out in our Care for Our Seniors Act, that will support our caregivers and protect access to care for our nation's seniors.”
View the survey results HERE.

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