U.S. nursing homes grapple with staffing shortages and requirements

New federal minimum staffing requirements for nursing homes could eventually require facilities that are paid by Medicare to hire tens of thousands of nurses and aides. But, like many industries around the U.S., these facilities are grappling with staffing shortages. Ali Rogin sits down with Jordan Rau, senior correspondent at KFF Health News, for more.
John Yang:
This week, Texas sued the Biden administration to try to block new federal minimum staffing requirements for nursing homes. The new rules could eventually require facilities that get money from Medicare to hire tens of thousands of nurses and aides. Ali Rogin looks into this controversial mandate.
Ali Rogin:
The nursing home rule announced in April phases in staffing requirements, including that a registered nurse be on site 24 hours a day, and that each resident get a minimum number of hours of direct care each day. But like many industries around the country, these facilities are grappling with staffing shortages.
We spoke to one nursing home worker who has been on the front lines of care for 34 years.
Bonnie Gaudraeau, Licensed Practical Nurse:
Not everybody’s teeth get brushed every day. People’s nails aren’t cut like they used to. Beds aren’t being made. Staff has to take shortcuts to get things done because there’s less of them to provide all those — all the care that the residents need.
The system is so broken and so short-handed and so difficult to manage with the different combinations of patients that you’re not able to provide the care for the people that really need it at the moments they really need it.
Ali Rogin:
The new rule faces pushback from the nursing home industry for being unrealistic, and from patient advocates who say it doesn’t go far enough.
Jordan Rau is a senior correspondent at KFF News, and has covered nursing homes for more than a decade. Jordan, thank you so much for being here. Why did the Biden administration want to put this role in place?
Jordan Rau, Senior Correspondent, KFF News:
Well, the pandemic really exposed the degree to which nursing homes were in dire straits. Over 200,000 people died in them just from COVID alone, and that put a lot of pressure on it. And so they really, there’s been pressure for years, really decades, to improve the core issues there, which are, you know, some of those were mentioned in just before, but also people falling a lot because of low staffing, bed sores or regular problems, people not getting their medication, people not getting food on time and such, and they saw this as an opportunity to really push hard and make some fundamental changes on staffing.
Ali Rogin:
It has been getting some backlash from various stakeholders. Why the backlash?
Jordan Rau:
Well, it’s very expensive. I mean, it’s going to cost billions of dollars to staff up for the industry as a whole. Now, some of these nursing homes already have enough staff to meet the minimum requirements that the Biden administration is requiring, but most don’t, and it’s going to be extremely expensive to hire those people, and a lot of people don’t want to take these jobs right now.
I mean, if you’re a nursing aide, the average pay is about $19 an hour. People don’t want to do that. It’s a very, very difficult job. So in some places they’ll have to increase the wages. So the industry claims that they can’t afford it, and so they’ve resisted it, both politically, they’ve gone to Congress, and they’re looking to block and overturn the rule, and also legally and going to the courts.
Ali Rogin:
So what else is behind these staffing shortages? Because apparently, you know, industry insiders will say there are 99 percent of these nursing homes that have open jobs, but they simply can’t find people to fill the jobs. Why is that?
Jordan Rau:
A lot of it is the money, but a lot of it is people also got burned out doing these jobs during the pandemic. I mean, it was brutal work. And, you know, watching your patients die was really, really difficult. The fact that these places are understaffed becomes a really bad cycle, because you — if you are in a nursing home that doesn’t have enough staff, your job is so much harder, and so it becomes harder to recruit people for those.
In most nursing homes, the average turnover in a nursing home is about 50 percent every year. There’s also a problem, and if there’s not really a career ladder for some of the people, so if you go in at the lower level, you’re not really working towards something.
And so a lot of people are like, hey, I can make, you know, the same amount of money, or more money working at Target or even working at McDonald’s, and it’s, you know, a much easier job.
Ali Rogin:
The labor unions that represent a lot of these nurses do support this role. And we heard from April Verrett of the Service Employees International Union, SEIU, who said, caregivers have been demanding safer staffing for years, and finally, feel heard now.
So what are nursing home workers who are currently in the industry telling you?
Jordan Rau:
Well, I mean, they’ve, you know, for a long time, felt undervalued, underpaid, also really resentful, because while there are a lot of nursing homes that are really in dire straits financially and closing up, there are also owners and corporations that have been making a lot of money off of the nursing homes.
There have been, you know, ones that are buying it up, and they just feel like there’s a lot of money out there that should be spent on the quality of staffing, and that has sort of been one of the major issues that isn’t being addressed in this rule, which is, you know, how much money can these do these nursing homes, or some of them, need to staff up at this level.
And there’s no money attached to the rule. It’s just, you’ve got to hit this level or else you’re in trouble.
Ali Rogin:
Are these nursing homes equipped to comply?
Jordan Rau:
You know, it’s hard to generalize, right? I mean, I think that there’s some nursing homes. There’s about, let’s say 20 percent that are doing it, there’s going to be about 20 percent that are going to be able to get a waiver from it, because they’re going to be able to demonstrate that there just aren’t enough, you know, qualified workers in their area.
And then the other ones, it really depends. It really comes down to what the administration does in terms of penalties, because if you are going to just cite them with a small financial penalty, for instance, it’s still in a nursing homes financial just forget the patients right for a second, and just look at the books, it’s still cheaper to pay the penalty than it is to staff up.
And so that’s the problem that the administration has when they decide exactly how they’re going to penalize or enforce this, because, on the flip side, if they penalize them too much, you can drive a struggling nursing home out of business.
Ali Rogin:
What do analysts say about whether this is a band aid on a bigger issue, or is this really getting to the heart of an industry that has been problematic for decades?
Jordan Rau:
It’s both. It’s a floor, right? This is minimum staffing. So no one is saying, like, if all your nursing homes are staffed at this level, the care is going to be fantastic. So it’s considered a good first step to bring up some of the worst nursing homes in the country to levels that are acceptable. There’s some really good nursing homes out there. There’s some really good care being given.
There’s some really good owners, but still, overall, the quality of care is not at the same level that you get in a hospital or you get in private pay, you know, at your home. And there’s still a long way to go to really get a high quality of care for some of the frailest Americans.
Ali Rogin:
Right at the heart of all of this is the patients who are very vulnerable people. Jordan Rau with KFF Health News, thank you so much for breaking this down for us.
Jordan Rau:
Thanks for having me.