From Bad To Horrible
Staff Shortages In Nursing Homes Worsen
When the Covid pandemic struck in early 2020, older people (so-called “elderly”) were the hardest hit, particularly those living in long term care facilities which can be germ factories at the best of times.
The result was that hundreds of thousands of folks in these homes around the world died, 170,000 in the United States alone.
We know how tragic the pandemic was at the time but it had serious knock-on effects once it passed.
Many care workers in nursing, critical care and retirement homes quit and found other, far less stressful occupations.
That has left the long term care industry with a huge problem: lack of nursing and nurses’ aide staff.
In the United States, nursing homes, for example, must provide a certain number of hours of care per day, per resident, in order to qualify for Medicaid payments from the states and federal government.
Those minimum levels of care were nowhere near being met following the pandemic. So the Biden administration issued new rules for care standards back in April in an attempt to improve the quality of care.
The rules won’t come into effect until 2026 to give the 15,000 nursing homes in the U.S. enough time to hire the staff needed to boost care times.
While residents (some are patients, frankly) remain immobile in their beds for lack of staff to get them to bathrooms or outdoors for fresh air, many are forced to defecate and urinate where they lie. It’s a disgusting way to live out the final years of one’s life but it is all too often the reality.
And while the Biden rules are an attempt, they are little more than window dressing on the problem because staffing remains low. Who wants to work for $19 an hour when a retirement home pays $23 an hour for far easier work. Hospitals pay even more.
Further, the federal rules lack explicit penalties for violations and offer broad exemptions for homes in areas with labor shortages.
So, how on earth can they have any impact at all?
Most of the 15,000 or so nursing homes in America are for-profit. Immediately, one can sense the problem. The nursing home industry operates on slim profit margins and federal rules that demand the hiring of more staff (from where, one wonders?) are not welcome by any of the operators. Not that they need to worry about being penalized, given that the federal rules lack any teeth.
That’s the sad reality; short of staff, no money to hire more staff and no new employees who want to come into a high-stress work environment for less than 20 bucks an hour.
As you might expect, employee turnover is ridiculously high in the industry. According to federal statistics, more than half of employees quit every year and must be replaced.
In short, it’s a shitshow.
However, come Monday, January 20, 2025, Donald Trump once again fills the Oval Office with his ego.
If Trump calls himself Tariff Man, then he could equally refer to himself as the Federal Anti-Regulation Cop. Many believe he will toss the Biden rules for nursing homes as overkill, overreach and just plain over-and-done-with-Biden.
For-profit operators in the nursing home industry will sigh with relief. However, one wonders if he would even try to understand what he’s rescinding.
Trump will never have to lie in a bed in an understaffed nursing home. And if it doesn’t affect him personally, then it’s not an issue.
This is not to sound anti-Trump for the sake of piling on the guy (so tempting…) but we have plenty of evidence from his first term in office that he’s not really interested in helping the common American.
Consider his denial of Covid for the first six months of the pandemic or his brilliant (“I’m a really stable genius”) solution to stop the spread by not bothering to count new Covid cases, thereby using a preposterous bit of twisted logic to convince Americans there was no pandemic.
However, if you live in Florida, then problem solved. Governor Ron deSantis (Trump’s Mini Me) decreed away the state’s staffing rules by declaring that any employee who engages with residents can be counted as a caregiver. So, the head of HR becomes a nurse or nurse’s aide.
As a result, only 5% of Florida care homes are considered understaffed. Before the 2022 legislation, 80% met the criteria for being understaffed. See? It’s all good.
But, for heaven’s sake, where does that leave those who must live in these facilities?
It may be cold comfort to further state that the situation in the European Union isn’t much better.
In a 2021 report, towards the end of the pandemic, EPSU, the European Public Sector Union, issued a report stating that Covid drove over 400 thousand nursing home workers out of the industry.
The report states, “The outbreak of Covid-19 exacerbated many problems in long term care already identified by EPSU for years – such as lack of funding, labour shortages, increasing psychosocial risks for care workers and accelerated privatisation of services”.
It’s difficult to envision a solution to this seemingly worldwide problem. With an aging population among the developed nations of the world, the only scenario one can see without difficulty is that the situation continues to grow worse.
As Trump famously whined back in 2016, “Who knew healthcare could be so complicated?”