US nursing home workers face ‘catastrophic crisis’ of understaffing

by Michael Sainato

For Linda Long, who has worked in nursing homes since 1997, at the same facility outside of Tacoma, Washington, since 2003, understaffing has always been a problem.

It only got worse during the Covid-19 pandemic, when she said co-workers were leaving due to the short staffing, constant Covid outbreaks and the immense workloads that staff were left with to fill in the void.

But, workers and labor experts say, short-staffing in the crucial US industry has persisted after the pandemic, with grave impacts on patient care and residents’ wellbeing, and spiraling burnout that has become pervasive in the care industry.

“Most of the time, I want to cry when I see things and I can’t do any more than I can do,” said Long. “There are times when we have extra people and we’re jumping for joy because I know the residents will have somebody to talk to, but in general we are still short-staffed, which means you look at the residents every day thinking. ‘Oh my God, how am I going to do this for them today?’”

Long said that the care many residents need has to be done by multiple people at a time, such as operating lifts to raise patients in and out of bed to bathe, to eat and to be active, and oftentimes nursing aides aren’t available to help complete these tasks. The short-staffing often results in workers skipping their breaks and lunches, and cutting corners wherever they can to save time so they can attend to every resident.

“You have to decide what to do, what you cannot do, but there’s not one task that can really be left out,” she said. “It really affects the wellbeing of the residents and yours, because you go home knowing you couldn’t do the things you need to do.”

She described the heartbreaking daily experiences she and other workers face when residents are weary about asking staff to help them with something because they see how short-staffed and overworked they are at the facility. And if tasks are skipped or missed, residents’ conditions can quickly deteriorate.

“Showers aren’t being done all the time because we can’t always get to it,” added Long. “People will lose the ability to walk, the ability to sit up, to do a range of motions, and that has a lot to do with being shorthanded because they don’t get any of the basic care they need.”

The Biden administration and labor groups are hoping for change. The US Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) has proposed a rule to implement minimum staffing standards in long-term care facilities, with the public comment period ending on 6 November. If implemented, it would be the first ever minimum federal staffing standard for nursing homes that care for 1.2 million people.

Under the proposed rule, the CMS estimates 75% of facilities would have to improve staffing in their facilities. The rule would require nursing homes to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident per day and 2.45 hours of care from a nurse aide per resident every day.

More than 50 unions, worker groups and organizations signed on to a letter in support of federal minimum staffing levels in nursing homes, including the Service Employees International Union (SEIU), the AFL-CIO and MomsRising.

“Our country’s long-term care system is in the midst of a catastrophic crisis, and nursing home workers and residents have suffered unspeakable consequences. In the absence of a federal staffing standard, nursing home workers have endured complete physical, mental and emotional exhaustion due to understaffed shifts and unsafe working conditions, and nursing home residents have been robbed of the quality care and quality of life they deserve,” said the SEIU president, Mary Kay Henry, in a statement supporting the standard.

But several nursing home CEOs have written public comments to oppose the rule, claiming it’s not feasible due to costs and labor shortages, with many workers and family members of residents writing in support of the rule or calling to strengthen it.

The nursing home industry is a multibillion-dollar industry with about 70% of nursing homes operating as for-profit facilities. In recent years, private equity firms have increased their ownership or stake in nursing homes, with research demonstrating that private equity ownership results in worse health outcomes.

Tina Siegel has worked as a licensed practical nurse in a nursing home in Erie, Pennsylvania, for 38 years, where she says staffing shortages have always been an issue in the industry but have worsened during the pandemic.

Earlier this year, Pennsylvania enacted statewide staff-to-patient ratios for nursing homes amid pushes from workers like Siegel, which she says have helped to improve staffing issues. She said the ratios are needed nationwide to improve working conditions for staff and the care and dignity that nursing home residents deserve.

“We feel really connected to our residents. We take care of them, some of them we’re the only family they have. We’re there when they’re passing away, and you want to spend time with them because you’re the only person there, but a lot of times you don’t have time to do that either. So … you feel bad because in their last moments of their life, they’re by themselves and that shouldn’t happen to people,” said Siegel.

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US nursing home workers face ‘catastrophic crisis’ of understaffing