A unique combination of investor interest, public attention and a floundering workforce offers the skilled nursing industry a unique chance to reinvent itself.
Owners and operators of nursing homes need to be working with industry partners to drive not just anyone to the SNF workforce, but individuals with a drive and talent to recast the way the industry is viewed from the outside, while increasing quality of care on the inside.
That’s in addition to a need for more staff once the Silver Tsunami rolls in — an anticipated influx of seniors needing skilled nursing care in about three to five years.
Robyn Stone of LeadingAge, the trade association for nonprofit senior housing and care providers, weighed in on all of these factors, and what she sees as the next evolution of staffing within the world of skilled nursing facilities.
She is senior vice president of research at Leading Age LTSSCenter@UmassBoston, and a co-author of the organization’s September 2020 Making Care Work Pay report.
As a researcher, what’s your take on SNF wage increases seen in some states, and their effect on the staffing crisis?
This is a very unique economic situation right now coming out of COVID.
A lot of industries are suffering in terms of hiring workers, so everybody’s paying more — I mean, the bonuses for LPNs [licensed practical nurses], we’ve heard examples that are just crazy off the charts.
What’s going to happen as we move into a more post-COVID [society]? What happens when the unemployment add-on goes away? What happens to this economy? Because a lot of this right now is also being driven by the economy itself. And the competition is fierce for workers everywhere. There’s a lot of inflation of wages. What’s going to happen when things settle down? Or is this a permanent phenomenon?
We’ve had worker shortages before, we’ve had challenges of undervaluing and underpaying these professionals, we’ve had a lot of turnover, but COVID has really exacerbated this whole situation. It’s created a situation where there’s a lot of money that’s come into these employers for a shortened period of time, that allows them to increase hazard pay, wage bonuses.
It sounds like nursing staff are uniquely situated to ask for higher wages, given the year we’ve had.
It’s ironic, because those of us who have been working on this for many, many years, we’ve always seen concerns about this workforce raised more in times when the economy was having challenges. The local economy was determining attention to this workforce.
I think the thing that’s happened here is that COVID, as a national and international experience, has peeled the onion back around this notion that these are not just unskilled, low-wage, low-paid workers, these are essential, competent individuals who need to be compensated and are essential for the care of a growing aging population.
What about higher wages through unions, other avenues?
Not all nursing homes are unionized. You’re only gonna have strikes where you’ve got unionized workers. And there’s plenty of places in the country where there are no unions. It’s going to vary.
We’re also in these incredibly competitive markets, the hospitals’ competitive markets, other industries within the same market area. It’s so hard to know how things are gonna level out.
This has raised an issue that’s not going to get put back into Pandora’s box, which I think is a good thing. The more that we can link payment reimbursement and compensation to skills, competencies, and knowledge and also the potential for growth and economic mobility, the better off we’re going to be.
A more highly trained, competent staff that is stable is associated with better quality outcomes for the people they’re caring for. So there is a connection. It’s not just that there’s an economic connection, there is a quality connection.
There’s $10 billion rumored for SNFs, out of remaining CARES Act funds, and another $3 billion from a rural fund in the American Rescue Plan (ARP). Do you think this will help jumpstart wage increases and investment in future talent?
I would hope that it certainly does affect that, that these dollars are going to be used for wages, for compensation, because this is a very labor-intensive sector.
There’s so much craziness going on in terms of wages, worker shortages and competition to actually pay more. [The employer] isn’t even thinking about the quality of the workforce that’s being hired, it’s really more of a warm body activity. We try to make sure that these dollars are used to fundamentally help with an infrastructure that’s going to be able to be maintained.
That’s the thing that I worry about the most.
So an investment in talent is needed, not just wage increases?
We are talking about the next 20 years of increased growth in the demand for this workforce.
It’s really the 80 and older population, that has a tremendous demand for services — that’s going to grow. Without a cure, we’re going to see more people with dementia.
The need for these services is going to grow, so these jobs are going to grow. Will the compensation, and the investment in the training and education that should be tied to good compensation, continue? You’ve got to have a strong workforce, the human capital infrastructure, to support it.
That is really the challenge. There is a lot of money going into the system right now, but that’s not a long-term investment. Thinking about how you use those dollars to help support a longer-term investment, and an infrastructure that’s going to stick, is what’s going to be really important.
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