No easy fix for nursing home staff shortage

The shortage of nursing home workers in our area and beyond isn’t likely to go away any time soon.

One reason for it is the current economy, which gives workers plenty of options but is tough for those competing to hire them. Nationally, just 3.5% of the workforce is unemployed, the lowest in roughly 50 years. In New York it’s not much higher at 4%, according to the U.S. Bureau of Labor Statistics.

Local nursing homes are desperate for staff at all levels, from registered nurse to certified nursing assistant, a job that doesn’t necessarily even require a high school diploma. They offer competitive wages, but many restaurants and supermarkets are increasing their pay, too. And there’s no way around the fact that nursing home work is harder than most; it involves lifting, bathing, cleaning up after our elders who can’t manage on their own so well anymore. For nurses, it’s scary to have so few of them on each shift, and many flee to work at places that aren’t so understaffed.

On the upside, nursing home work is also more honorable than most jobs, and people appreciate the service — even if it doesn’t always seem like it.

The economy will eventually shift in favor of nursing home employers, but even then, demographics will keep exacerbating this particular staff shortage for at least a decade or two. Soon, the huge generation of Americans born in the baby boom after World War II will start entering nursing homes. The later generations that make up the work force are smaller, and therefore the ratio of people of nursing home worker age (18 to 64) to senior citizens (65 and older) has shrunk rapidly. In 1900 the ratio was 13.6 to 1, but by 2014 it was 4.3 to 1, and by 2030 it is projected to be 2.8 to 1. Management at Mercy Living Center in Tupper Lake says it’s already close to 2.8 to 1 in the Tri-Lakes area, which is credible since demographic studies consistently show the Adirondack Park has an older average population than all but a few parts of the U.S.

Again, there’s no easy fix. Raising wages would be nice, if those who run nursing homes can afford it. But much of their revenue comes from Medicaid, which is being blamed for blowing a big hole in New York state’s budget. Caring for the low-income and elderly is a better use of public funds than most, but New York spends more on Medicaid than other states. If state leaders cut Medicaid, nursing homes might find themselves unable to afford even the staff they have now. Will we have to get used to lower expectations of nursing home staffing?

Some Democratic lawmakers are going in the other direction. U.S. Sen. Kirsten Gillibrand is concerned about neglect and abuse of nursing home residents, and she has proposed a bill that would enact more strict requirements for hiring staff in these facilities. Even now, however, the management at Mercy Living Center tells us one of its biggest obstacles to hiring is the “fingerprinting cliff,” which means many job applicants can’t pass a criminal background check. There is room for reasonable people to discuss giving a second chance to someone who got in trouble in their youth and hopefully learned their lesson, but as of now, nursing homes generally don’t hire anyone with a criminal history. Gillibrand’s bill would likely screen out even more applicants. It is good to hold a high standard, but is this the time to raise it?

Meanwhile in Albany, lobbyists are pushing a bill that would require “safe staffing” levels at all nursing homes. How could they require, by law, something that currently isn’t possible for many nursing homes, despite their best efforts? All it would do is punish the hardest hit with fines, perhaps even drive them out of business.

We want citizens and lawmakers to understand the reality of the nursing home climate, because no matter how much we complain or how many laws we pass, it’s going to be with us for a while. For now, perhaps the best things we can hope and work for are steady financial support and good workers to step up and serve our elders — who will include the rest of us in a few years.


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