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Workforce crisis worsens

January 1, 2009
by Bob Gatty
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The nation's nursing home industry is facing a critical, and apparently worsening, workforce crisis and is urging the federal government to step in and help.

The American Health Care Association (AHCA) released a survey in November of nursing position vacancies and turnover in 2007, which found that nearly 110,000 full-time equivalent (FTE) healthcare personnel were needed to fill vacant nursing positions in facilities nationwide, and if trends continue, that shortage could grow to 120,000 FTEs over the next five years.

Nationally, vacancy rates for staff registered nurses stood at 9.5% and at 10% for administrative RNs. Staff turnover for staff RNs, licensed practical nurses, and directors of nursing, stood at about 38% to 50% across all three positions, while the turnover rate for CNAs, who are responsible for much of the direct, hands-on resident care, was estimated at 66%—with more than 60,000 vacancies.

Attracting quality employees

Exacerbating the problem is the difficulty many facilities are having in attracting qualified employees. “Many complex factors contribute to the difficulties that nursing facility administrators face in staffing nursing services, including competition for healthcare workers from other healthcare providers and the challenge of creating a rewarding and satisfying work environment,” the AHCA report says. “Demographic changes, economic conditions, capacity of the nursing education system, regulatory and legislative activities, nursing facility operating environments, and the individual needs of nursing facility residents factor in the supply and demand problem of the nursing workforce,” the study adds.

It pointed out that efforts in the industry “to sustain and enhance quality long-term care” has resulted in more positions being provided, thus increasing the demand for well-trained nursing staff. From 2002 to 2007, established direct-care positions have increased 11% from about 960,000 to more than 1,040,000, while concurrently total vacant direct-care positions have increased 15% from 96,000 to 110,000, the study says.

“Our national long-term care workforce is facing a shortage crisis, which must be remedied to ensure that our community is able to provide high-quality care to the millions of frail, elderly, and disabled Americans we care for,” says Bruce Yarwood, AHCA president and CEO. “We urge Congress to initiate reforms that have the resources to bolster this labor force, and allow our profession to build a pipeline of qualified workers to meet the needs of an aging America.”

Yarwood says that “funding and expanding training programs to ensure a large, well-trained labor pool is essential to growing our workforce,” adding that “significant steps must be taken to ensure that the increasingly complex levels of care provided in nursing homes are maintained by a workforce that is qualified to meet the needs of our nation's most vulnerable population, especially as 77 million baby boomers move toward retirement.”

AHCA pointed to an Institute of Medicine (IOM) report published in April 2008 that outlines the need of the nation to strengthen the healthcare workforce that is charged with caring for older Americans. The IOM report stresses that the new generation of older Americans will be “the most diverse the nation has ever seen with more education, increased longevity, more widely dispersed families, and more racial and ethnic diversity, making their needs much different than previous generations.”

The report says that the “dramatic shortage of all types of healthcare workers, especially those in long-term care settings,” is a problem and pointed out that the overall healthcare workforce is inadequately trained to care for older adults.

According to the IOM study, today's healthcare workforce receives little geriatric training and is unprepared to deliver the best possible care to older patients. In fact, the ad hoc committee charged with developing the report recommended that healthcare professionals should be required to demonstrate their competence in the care of older adults as a criterion of licensing and certification.

The committee also recommends that training standards for these workers be strengthened by increasing existing federal training requirements and establishing state-based standards.

To encourage more healthcare providers to specialize in geriatrics, the committee recommends that financial incentives be provided to increase their number in every health profession, including increasing payments for their clinical services, developing awards to increase the number of faculty in geriatrics, and establishing programs to provide loan forgiveness, scholarships, and direct financial incentives for choosing geriatric care.

The committee also points out that direct-care workers typically have high turnover levels, as was evidenced in the AHCA survey, as well as high rates of job dissatisfaction. The panel blames low pay, poor working conditions, high rates of on-the-job injury, and few opportunities for advancement for those problems.

“To help improve the quality of these jobs, more needs to be done to improve job desirability, including improved supervisory relationships and greater opportunities for career growth,” the IOM study says. “To overcome huge financial disincentives, the committee recommends that state Medicaid programs increase pay for direct-care workers and provide access to fringe benefits. The nation needs to move quickly and efficiently to make certain that the healthcare workforce increases in size and has the proper education and training to handle the needs of a new generation of older Americans,” the IOM study concludes.

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