Staffing Shortages: What Do They Mean for Aging Services?
By Catherine Gill, St. Luke CEO and Administrator
Every sector is experiencing staffing shortages lately. Your favorite pizza shop isn’t delivering on weekdays, your pharmacy has cut back on its hours, and there’s a long line at the grocery store because it has only three cashiers. You look around in a restaurant and see empty tables, but there is still a 45-minute wait because it only has one server. Or perhaps your favorite restaurant is now only open Wednesday through Saturday because it can’t find enough staff to remain open all week in the way it did before.
In health care, these staffing challenges are particularly distressing. There is a widely recognized, nationwide shortage of nurses, aides, and medical professionals. This is of significant concern to public health officials and, of course, the general public.
With growing wait lists for nursing home beds and home care, staffing shortages among long-term care providers are attracting more attention. Why is that, and how did we get here?
There has been a mounting long-term care and aging services workforce crisis since before the COVID-19 pandemic arrived in early 2020. Some of this is simply due to changing statewide demographics. Between 2015 and 2040, the number of adults age 65 and over will increase by 50 percent, and the number of adults over 85 will double. At the same time, the percentage of our population between ages 18 and 64 is shrinking.
Today, there are only approximately four working-age adults for every adult over age 65 in New York and 29 working-age adults for every adult over age 85. So, while there is an increasing demand for long-term care services as people age, we have far fewer workers available to help serve older adults.
However, another fundamental reason for the staffing challenges in long-term care is a severe lack of funding. Nursing homes, home health care, and many other services rely heavily on state and federal funding. Thus, the wages providers are able to offer staff rely heavily on Medicaid and Medicare reimbursement.
For example, nearly 75 percent of the nursing home care delivered in New York is paid for by Medicaid (including St. Luke). Meanwhile, the nursing home Medicaid rates have not been updated or adjusted to account for inflation and rising costs of providing medical services since 2007! Since then, the cost of providing these critical services has grown by 42 percent. To illustrate this point, on average, St. Luke Health Services is underfunded on average $131 dollars each day for every resident we care for who depends upon Medicaid as their primary healthcare insurer.
Unlike employers in other sectors, nursing homes can’t raise their prices in order to offer competitive wages because the “price” that the State pays was fixed in the early 2000s. And they can’t reduce their hours of service to reduce the costs of operating, because nursing home residents need care 24 hours a day, seven days a week.
A similar challenge is experienced in home care, as many home care agencies rely very heavily on Medicaid and others rely on Medicare. In both nursing homes and home care, when the government does not pay adequate rates, the providers do not have the resources to be able to pay staff appropriately for the hard work that these caregiving jobs entail.
When the government shortchanges long-term care and aging services providers and does not offer reimbursement that reflects current costs of providing care, it is the staff and the patients who pay the price.
Nearly three-quarters of those who live beyond age 65 will need long-term care services at some point. With a growing population of older adults, we must do more to recognize and reward our dedicated aging services workforce. It takes a special set of professional and personal skills to be able to care for people at their most vulnerable. Don’t we all want our loved ones to receive the type of care we would, as families, provide – if only we could? Don’t we want the same for ourselves?
The first step to recognizing these workers, and thanking them for all they do, is to create a system that allows for proper compensation – and that begins with updating Medicaid rates to reflect current costs.