States Hardest Hit by Long-Term Care Staffing Shortage

Many industries are facing staffing shortages as the economy grapples with the Great Resignation, but few industries have been as impacted as much as long-term care (LTC) facilities like nursing homes and assisted living communities. 

Residents and staff at LTC facilities have accounted for 23% of COVID-19 deaths through January 2022, causing a staff shortage that in turn contributed to already very difficult working conditions. This has led to a record number of workers quitting. As baby boomers continue to age, this has created an enormous hole for American seniors and their families in need of quality long-term care. 

The average person turning 65 today has a nearly 70 percent chance of requiring some type of long-term care to meet their health or personal care needs as they age. While this care is more often provided in-home than in formal care facilities like nursing homes or assisted living facilities, the formal long-term care industry plays an enormous role in our society.  

An American Health Care Association survey in the fall of 2021 found that 86 percent of nursing homes and 77 percent of assisted living facilities said their staffing picture had gotten worse during the previous three months — only 1 percent of these organizations said things had improved.

We wanted to understand the nature of staffing shortages at long-term care facilities across the country, so we did a deep dive into data published by the Centers for Medicare and Medicaid Services on staffing shortages at LTC centers amid the ongoing pandemic and continued ups and downs of the job market.

Key findings:

• Only 11 percent of facilities said they had a staffing shortage in May 2020 during the first week that data was collected; that figure rose to about 22 percent by January 2022.
• An average of about one-quarter of LTC facilities have reported shortages in nursing staff so far in 2022, an increase from 16 percent in 2020.
• About 41 percent of facilities in Minnesota are reporting staffing shortages in 2022, the highest rate in the country.

Staffing shortages surge over past two years

Before the situation began to ease slightly starting in February, on average, more long-term care facilities had been reporting staffing shortages. An average of 17 percent of facilities reporting to the federal government for the week ending February 27, 2022 (the most recent available data) said they had shortages of nursing, clinical, aides, or other staff. That’s a substantial increase from the week ending May 24, 2020, the first week for which the government collected and reported this data, when the figure was just 11.1 percent.

That’s a huge increase, to be sure, but it could be worse. At its peak, this rate was more than 22 percent, for the week ending January 16, 2022. So, while the situation has improved, it’s far from a certainty that it will keep getting better.

The biggest shortages have consistently appeared in employment of nursing workers (registered nurses, licensed practical nurses, and vocational nurses) and aides (certified nursing assistants, nurse aides, medication aides, and medication technicians). 

Since 2020, an average of about 20 percent of all long-term care facilities have reported shortages of these types of workers, and 2022 is the worst year of the three, with one in four LTC facilities reporting shortages in nursing workers or aides.

Less common are shortages in clinical staff, which includes physicians, physician assistants, and advanced practice nurses. It’s notable that this category includes those who are most likely to be well-paid. According to data from the U.S. Bureau of Labor Statistics, the average U.S. physician makes $208,000 per year, while physician assistants make $115,000 on average, and nurse practitioners (one type of advanced practice nurse) make about $112,000. Contrast that with registered nurses, who make about $68,000 in nursing and residential care facilities, or nursing assistants, who can expect to earn $30,000 on average.

Still, while an average of 3.5 percent of LTC facilities say they’re experiencing shortages of these types of workers in 2022, that’s an increase of almost a percentage point since 2000, which means even LTC workers who tend to be highly paid are becoming harder to come by.

Other staff and personnel not included in other categories, including environmental services employees, are also becoming more scarce. In fact, the share of facilities reporting a shortage of these workers has nearly quadrupled since 2020.

2022 shortage worst in Minnesota, Washington and Maine

Generally, most states have had periods of intense staffing shortages at long-term care facilities, both overall and for specific jobs, and 2022 is shaping up to be rough in many places across the country when it comes to finding qualified workers at nursing homes and assisted living communities.

Taking into account the four job types, an average of 41 percent of LTC facilities in Minnesota are experiencing staffing shortages in 2022, while Washington and Maine (about 38 percent each) are close to that level.

But, of course, not every state is in the same spot. California, for example, has fared well when it comes to staffing of LTC workers, and so far in 2022, only about 2 percent of facilities in that state say they’re running low on qualified employees.

Additionally, while most states mirror the nation when it comes to the situation with LTC staffing worsening, a handful are trending in a good direction instead of a bad one. Comparing annual average shortages across all four jobs, fewer facilities are reporting shortages in 2022 than were doing so in 2020 in Texas, Arkansas, and Connecticut, though in all three cases, improvements have been modest.

Long-term care staffing shortages by state

2022 average in share of long-term care facilities reporting staffing shortages and percentage-point change in 2020 average

While shortage rates tend to mirror national trends when looking at the four individual types of jobs, there are some notable outliers — both positive and negative. On the negative side, while only about 3 percent of LTC facilities in the country in 2022 have reported experiencing a shortage of clinical staff, including physicians, PAs, and advanced practice nurses, that rate is almost 12 percent in Maine. Facilities in Alaska are reporting a shortage of aides at a rate of 61 percent so far in 2022.

On the other hand, while the nursing shortage is worst on a national level, only 3 percent of California facilities are running low on nurses, and less than 1 percent say they’re short on clinical staff. Other states are consistently below the national rates for all four job types, including Texas, New Jersey, Massachusetts, Connecticut, and Arkansas.

State LTC staffing shortages by job, 2022

Percentage of facilities reporting shortage in workers by job*

* Through Feb. 27, 2022

Tips for finding safe and reliable long-term care

If you’re searching for a long-term care facility in your area and you’re concerned about staff shortages, we have some tips on how to evaluate assisted living communities and skilled nursing facilities. 

1. Read recent community reviews: There are many five-star facilities that have been hit hard by the Great Resignation. Even if a facility has strong ratings, it is important to read recent reviews to see if there has been an increase in negative reviews in recent times.
2. Take tours and talk to residents: Once you narrow down a few options, take multiple tours at different times of day. Try to attend a meal or activity and talk to current residents to get the inside scoop. Keeping in mind it is important to talk to several people to get varying opinions.
3. Create a checklist of questions: You can and should expect any long-term care facility director to be able to answer these questions:
   • What is the ratio of staff to residents and has this declined since 2020?
   • How does your community take care of its caretakers?
   • What is the staff turnover rate?
   • What types of training do the staff members have?
   • Are background checks performed on staff members?
   • Is there staff available to provide 24-hour assistance?
   • Is there a Registered Nurse, Licensed Vocational Nurse, or Certified Nursing Assistant on staff?  If so, how often?
   • Is there staff available to provide 24-hour assistance with activities of daily living (ADL’s) such as dressing, eating, bathing and toileting?
4. Consult local physicians and healthcare professionals: Before deciding on a facility, consult your loved ones’ physician or care manager. They will have their finger on the pulse and can help guide you towards the best possible decision.

Conclusion

For any family, deciding on a long-term care facility for a parent or other loved one is a difficult process that is often fraught with anxiety. But in many places across the country, staffing issues are likely (unfortunately) contributing to challenges in evaluating and finding the best spot. However, as our analysis finds, the situation may be easing nationally, and in some states, it’s already gotten better.

Methodology

For this report, we analyzed a broad, multi-year dataset published by the Centers for Medicare and Medicaid Services (CMS). We ran custom queries of the agency’s COVID-19 nursing home data publication to determine the percentage of long-term care facilities in each state, and the nation as a whole, which reported staffing shortages of nursing staff, clinical staff, aides, and other staff. Data begins in May 2020, and our analysis ran through February 27, 2022.