Labor Crisis in Long-Term Health Care Getting Worse

Long-term health care providers face a crisis of historic proportions as they face an unprecedented workforce crisis. Recent data from the Bureau of Labor Statistics shows that long-term health care facilities have lost over 400,000 employees from February 2020 to March 2022, far outpacing other health care sectors. In a story in Skilled Nursing News, the nursing home industry lost 2,500 jobs in March 2022 alone.

The labor shortage in long-term care far outpaces other health care industry sectors. Caregivers face burnout as existing employees work harder due to staff shortages. Many caregivers leave long-term care for other opportunities as providers cannot compete with other employers for salaries and benefits.  

The impact of the COVID-19 virus crisis is being felt throughout health care, including long-term care. Some professional caregivers and staff decide the risks outweigh the benefits of their jobs, considering the stress, extra workload, and lower pay.

More Professional Training May Help

Some facilities have taken proactive action. A facility in Florida has implemented an in-house certified nursing assistant (CNA) training program to prepare its staff to step into the vacant positions. In Minnesota, similar initiatives are being led by the state, with nearly $7 million invested in continuing training programs.

Mark Parkinson, president, and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), explained in Skilled Nursing News that offering positions with comparable pay to those within other health care settings are crucial to reaching a solution to workforce woes within the industry.

"We're going to not only have to be great employers on the engagement and satisfaction side, we have to have jobs that can compete with other sectors," Parkinson said.

Facilities Limiting Admissions or Closing

As a result of the staffing shortage, many facilities across the country are being forced to limit admissions or close down altogether. A growing number of seniors are being forced from their facilities because of closures. Other seniors find it more challenging to find facility care as facilities limit admissions.

The consequences have increased the stress on family members who often must become family caregivers as other choices are either unavailable or too costly. 

Medicaid facilities are hardest hit as they face chronic Medicaid underfunding and unfunded government mandates. However, private pay facilities face budget issues as well and attempt to pay some of those higher costs to the care recipients, who often have limited income themselves. 

Medicare and health insurance will only pay a limited amount of long-term care, while Long-Term Care Insurance provides full benefits, many people don't have the product, nor can they purchase it 'when they need it". 

White House has Ambitious Plan to Address Staffing

In early 2022 the White House outlined an ambitious plan to improve the safety and quality of nursing home care. The proposal would establish a federal minimum staffing requirement for nursing homes funded through Medicare and Medicaid.

"CMS (Centers for Medicare & Medicaid Services) has long identified staffing as a vital component of a nursing home's ability to provide quality care, and CMS has used staffing data to more accurately and effectively gauge its impact on quality of care in nursing homes," said CMS Administrator Chiquita Brooks-LaSure.

A White House statement said President Biden believes we must improve the quality of our nursing homes so that seniors, people with disabilities, and others living in nursing homes get the reliable, high-quality care they deserve. The White House statement says that despite the tens of billions of federal taxpayer dollars flowing to nursing homes each year, too many continue to provide poor, sub-standard care that leads to avoidable resident harm.

The President's proposed reforms include:

• requiring every nursing home to have a sufficient number of staff who are adequately trained to provide high-quality care;
• poorly performing nursing homes are held accountable for improper and unsafe care and immediately improve their services or are cut off from taxpayer dollars; and
• provide the public with better information about nursing home conditions to find the best available options.

Long-Term Health Care Costs Climbing

Paying for long-term health care has been expensive, but the costs are rising rapidly nationwide due to labor shortages and increased demand for long-term care services. 

Long-term health care costs vary depending on where a person lives. The LTC NEWS Cost of Care Calculator shows both current and future costs of all levels of care based on location - Cost of Care Calculator - Choose Your State | LTC News.

For example, below, you will see the LTC NEWS national average compared to California's cost of care. California is one of the more expensive states for long-term health care. 

While Long-Term Care Insurance is available, many consumers either decide they don't need the coverage or think they will never need care in the future. Some states have tax incentives available to encourage the purchase of coverage. In addition, federal tax incentives, including tax deductions and the allowed use of pre-tax money in Health Saving Accounts, are available to encourage families to consider insurance coverage.

Partnership LTC Insurance

Long-Term Care Insurance is not appropriate for some families since the insurance is primarily geared toward those with assets to protect. The Long-Term Care Insurance Partnership Program is available in most states. These specially designed plans provide dollar-for-dollar asset protection if you own a qualified policy. People with more modest levels of savings can purchase a smaller plan and shelter their assets with a very affordable policy—the larger the policy benefits, the larger amount of asset protection.

Premiums vary depending on age, health, family history, and the amount of benefits in the policy. Premiums can vary over 100% between insurance companies. 

For example, a couple, both age 55, in good health, can purchase $3000 a month with a three-year benefit period and 3% compound inflation, partnership certified, for a range from $222 a month to as much as $375 a month for the couple. 

LTC Insurance is custom designed so benefit levels can be increased or decreased. Policies will pay for in-home care, adult day care centers, assisted living, memory care, and nursing homes. 

States Becoming Punitive

Some states are thinking more punitive to either increase Medicaid funding or push people to insurance. The State of Washington is implementing an income tax specifically for long-term care. The tax is on 100% of earned income for anyone age 18 and older in the state. The only way to avoid the tax is to own and maintain a Long-Term Care Insurance policy. Now, at least twelve other states are considering similar taxes. 

Medicaid remains the biggest funding source for long-term health care but will only provide benefits if the care recipient has little or no income and assets. However, Medicaid reimbursements to facilities are low, and the quality of care can suffer. Labor shortages make this crisis even more significant.