Staffing shortages, poor infection control plague nursing homes

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The report, issued Thursday by the Inspector General's Office at the U.S. Department of Health and Human Services, showed that infection-control procedures were still sorely lacking at many facilities. Photo by Adobe Stock/HealthDay News

Although the pandemic has ended, staffing shortages and employee burnout still plague U.S. nursing homes, a new government report finds.

But the problems didn't end there: The report, issued Thursday by the Inspector General's Office at the U.S. Department of Health and Human Services, showed that infection-control procedures were still sorely lacking at many facilities.

Not only that, COVID-19 booster vaccination rates remain far lower than they should be, with only 38% of residents and 15% of staff up-to-date on their shots, according to a recent KFF report.

"Just as airplanes cannot be repaired while in flight, nursing home challenges could not be fully repaired during the pandemic," Rachel Bryan, a social science analyst with the inspector general's office, told the New York Times. "We feel very strongly that as we come out of emergency mode, we take the time to reflect, learn and take real steps toward meaningful change."

Staffing problems are "monumental," the report said, noting high levels of burnout, frequent employee turnover and the time-consuming burdens of constantly training new employees. For nursing homes, the inability to hire and keep certified nurse aides, food preparation staff and housekeeping workers is tied to federal and state reimbursements that do not cover the full cost of care, the Times reported.

The report, based on interviews with two dozen nursing home administrators from across the country, shows that nursing homes are still reeling from the damage inflicted by the pandemic, when shortages of personal protective equipment (PPE) and widespread fear of infection drove away seasoned employees.

The challenges of trying to recruit reliable help has been exacerbated by private staffing agencies that step in quickly but charge nursing homes as much as 50 percent more for workers, the Times reported.

Katie Smith Sloan, president of LeadingAge, an association of nonprofit nursing homes, told the Times that higher federal reimbursement rates would help, but that mobilizing numerous government agencies would be a better strategy.

For example, she said, the Department of Homeland Security could include nursing aides in the temporary worker visa programs that bring in farm workers from abroad, and the Department of Education, with support from Congress, could make Pell grants available to nursing assistant students and culinary worker trainees.

"This is bigger than CMS," Sloan said, referring to the U.S. Centers for Medicaid and Medicare Services, which oversees nursing homes. "We have to figure out how to creatively apply the things that work to this intractable work force issue."

The report was not without a few bright spots: Many nursing home administrators said dire shortages of PPE have eased since 2021. And some nursing homes have been successful when they got creative in trying to retain staff, using hiring bonuses, free staff meals and licensing waivers that allow nursing assistant students to get on-the-job training.

Still, many experts say how the country cares for its aging population has to fundamentally change.

"The pandemic helped highlight the challenges facing nursing homes, but it's still the elephant in the room," Elizabeth White, a professor at Brown University School of Public Health and an expert in long-term care, told the Times. "The financing system is broken, and the problem is just so enormous that it's very hard to get the political motivation to do anything about it."

More information

The American Health Care Association/National Center for Assisted Living has more on nursing home staffing shortages.

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