Nursing homes are the hardest hit by the decline in health care employment

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Among health care employment sectors, nursing homes are the most adversely affected by the post-pandemic decline in employment growth — a rate more than three times higher than hospitals or doctor’s offices, a University of Michigan researcher says.

Nursing home occupancy is 10.5 percent below pre-pandemic levels, compared with 3.3 percent for hospitals and 1.6 percent for doctor’s offices, according to a study by Thuy Nguyen, assistant professor of health management and policy in UM’s School of Public Health , and colleagues.

The study, published Nov. 2 in JAMA, evaluated health care employment levels before and after the pandemic to identify subsectors most affected by job losses and recovery.

Shortages of nursing home workers — and health care workers in general — are not new, but the study could help change policy, including a federal proposal targeting staffing levels in skilled nursing facilities, or SNFs, said Nguyen, who is the lead author. of the study.

“The Biden administration’s proposed nursing home staffing standards are intended to increase nursing home staffing by setting national mandatory minimum nursing staffing levels, which has the potential to positively impact declining SNF occupancy rates and ultimately improved quality outcomes for nursing home residents,” Nguyen said.

“The results of our research can help define the scale of the challenge facing policymakers. These declines in NHC employment rates are likely multifaceted in nature, and the Biden administration’s proposal alone is unlikely to fully address the myriad causes of declining employment in this health care subsector.”

Nguyen and co-authors Christopher Whaley of Brown University, Kosali Simon of Indiana University and Jonathan Cantor of the RAND Corp. used the US Census Bureau’s national labor statistics to estimate the recovery of employment after the initial decline in employment following the public health emergency in March 2020 through the end of 2022.

“These data come from the Census of Employment and Wages, which covers 95 percent of U.S. jobs. As the post-pandemic recovery continues, these same government databases will be important to monitor for future changes in healthcare employment,” said Simon.

The study fills a research gap by offering more recent data than is typically available to assess the broad health care workforce, says Nguyen, who examines the worker shortage below.

What is your opinion on the direction of the staffing shortage? Will it get worse before it gets better?

Understanding the causes and consequences of the differing patterns of health care employment recovery is beyond the scope of our study, but our findings highlight the potential for further declines in employment in certain fields, such as long-term care workers. These results are alarming because they suggest long-term effects of the COVID-19 pandemic on declining health care employment, such as decisions by long-term care workers to leave the industry. I think that without a more focused effort by policy makers and healthcare organization leaders, we may not see a brighter picture of employment in long-term care in the near future.

Any surprising findings?

It was surprising that health care employment declined more slowly than non-health care employment in 2020, but recovered less quickly in 2022. Patterns of employment recovery varied significantly by health care subsectors. For example, staffing in SNFs was already down before the pandemic and has fallen further since the pandemic – 12% below the pre-pandemic level by the end of 2022, while staffing in doctors’ offices has reached pre-pandemic levels.

What kinds of policy changes are needed or already happening?

Addressing the long-term care workforce shortage is a pressing public health issue in the United States. Among ongoing policy changes, the Biden administration’s new proposal to set national mandatory nursing minimum levels may improve the situation to some extent.

However, this proposal alone is unlikely to fully address declining employment among long-term care workers, as many of these workers have faced various struggles such as burnout, lack of affordable child care, and modest levels of wages. Healthcare leaders should consider increasing wages and improving working conditions for long-term workers to address short-term employment shortages while focusing on long-term retention. The government should provide additional financial support and make it easier for people to start careers in nursing homes or other health care sectors.

How concerned should patients, healthcare workers be about staff shortages?

Current staffing shortages in nursing homes are likely to continue to exacerbate staff burnout and high turnover. Higher levels of nurse staffing and a higher skill mix appear to be associated with better outcomes for nursing home residents. This raises concerns about the quality of care in nursing homes among patients, healthcare professionals, and healthcare organization leaders.

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