Nursing homes most adversely affected by employment declines since the pandemic

Among health care work sectors, nursing homes have been hit hardest by the decline in employment growth from the pandemic — three times more than hospitals or physician offices, a University of Michigan researcher said.

Nursing home employment is 10.5% below pre-pandemic levels, compared with 3.3% for hospitals and 1.6% for physician offices, according to a study by Thuy Nguyen, assistant professor of health management and policy in the U-M School of Public Health and fellow.

The study was published in November. 2 in JAMA assessed pre- and post-pandemic health care employment levels to identify the 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 inform policy changes, including a federal proposal to target staffing levels at skilled nursing facilities, or SNFs, said Nguyen, who is the lead author. of study

The Biden administration’s proposed nursing home staffing standards aim to increase nursing home staffing by setting nationally mandated minimum nurse staffing levels, which could positively impact SNF employment levels and ultimately have the potential to improve quality outcomes for nursing home residents.”

Thuy Nguyen, assistant professor of health management and policy in UM’s School of Public Health

“Our research findings can help policymakers determine the scale of the challenges they face. These declines in SNF employment levels are likely multifactorial in nature, and the Biden administration’s proposal alone is unlikely to fully address the myriad causes of employment declines 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 Corporation. The US Census Bureau used national labor statistics to assess the recovery of employment since the initial decline in employment following the March 2020 public health emergency through the end of 2022.

“These data come from a Census of Employment and Wages that covers 95% of jobs in the United States. As the post-pandemic recovery continues, these same government databases will be important to look at future changes in healthcare sector employment,” Simon said.

The study fills a gap in research by providing more recent data than is typically available to assess the broader health care workforce, said Nguyen, who addressed the workforce shortage below.

What is your opinion about the staffing crisis? Will it get worse before it gets better?

Understanding the causes and consequences of dissociating recovery patterns in health care employment is beyond the scope of our study, but our results underscore the potential for further declines in employment in certain sectors, such as long-term care workers. These findings are worrisome because they suggest long-term consequences of the COVID-19 pandemic on health care employment declines such as long-term care workers’ decisions to leave the industry. I think we won’t see a brighter picture of long-term care employment in the near future without more targeted efforts by policymakers and healthcare organization leaders.

Any surprising results?

It was surprising that health care employment declined less rapidly than non-health care employment in 2020 but recovered less quickly in 2022. Patterns of employment recovery varied greatly by healthcare subsector. For example, staffing in SNFs had already declined pre-pandemic and declined further post-pandemic — 12% below pre-pandemic levels by the end of 2022, when staffing in people’s offices 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

However, this proposal alone is unlikely to fully address declining employment among long-term care workers because many of these workers face various struggles such as burnout, lack of available child care, and modest wage levels. Health care organization leaders should consider increasing wages and improving working conditions for long-term care workers to address short-term employment shortages while also focusing on long-term retention. The government should provide more financial support and make it easier for individuals to enter careers in nursing homes or other healthcare sectors.

How should patients, health care workers be concerned about staff shortages?

Current staffing shortages in nursing homes will exacerbate staff burnout and high turnover. A combination of higher levels of nurse staffing and a higher skill set appears to be associated with better quality outcomes for nursing home residents. This raises concern for quality of care in nursing homes among patients, healthcare workers, as well as healthcare organization leaders.