In nursing homes, staff are key. But is Biden's boost for the workforce realistic?

Earlier this spring the Biden administration announced a new standard on staffing levels for nursing homes. Employee turnover at nursing homes shot up during the pandemic, when more than 200,000 residents and staff died. The government says more staff translates to better care. Nursing homes agree. But they say mandates are the wrong way to go about it.

Registered nurse Vida Antwi has spent 20 years working at Gurwin Jewish Nursing & Rehabilitation Center in Commack, Long Island, and says she loves her job. Speaking to a resident who laments that she doesn’t have family around, Antwi says, “You got family here. We’re all your family. Don’t I tell you that?”

Gurwin is a nonprofit nursing home. It has art photography on the walls, plenty of natural light, a couple of rehabilitation gyms and regular events for residents. There’s a sunny courtyard where people can gather on nice days, and a large, colorful fish tank in one of the downstairs corridors. Staff are friendly and the place is clean.

In short, this is a nice facility. But even here the administration has had trouble keeping staff since the pandemic.

Antwi credits her employer with making a big effort to hire and train new nurses and nursing assistants coming out of COVID. Still, she says, “Even though we try to get people on board, some people come and they just leave. But I think you have to stand up and do the best you can.”

Antwi’s boss, Stu Almer, CEO of Gurwin Healthcare System, says turnover is now under 30% — quite an improvement over recent years: “Our turnover rate last year and the year before was much higher,” he says. Nationally, turnover is still above 50%.

The Gurwin facility is a member of LeadingAge, which represents nonprofit providers of aging services. LeadingAge recently joined a lawsuit brought by the American Health Care Association, which represents many for-profit nursing homes, among other facilities. Both organizations say the rule will hurt nursing home residents rather than help them, because it’s too hard to implement.

“We need real policy solutions and investments, not mandates,” says Katie Smith Sloan, president and CEO of LeadingAge.

Almer says although staff levels at his facility are heading in the right direction, he still doesn’t have all the nurses and nursing aides he needs. He’d love more, but says given the country’s nursing shortage, how is he meant to find them?

“There just aren’t enough staff,” he says. “It makes us curious as to why standards like this go into effect and we’re all competing for the same quality staff to run a good facility.”

He says nursing homes compete with hospitals for nurses, but even hospitals are having trouble hiring. He adds that certified nursing assistants are the backbone of nursing homes, but they’re in short supply, too. To plug the gap, Gurwin has set up a training program for entry-level support staff it calls “resident care associates.”

The organization hopes they’ll stay on at Gurwin, where they can also become certified nursing assistants, with on-site training and exams. And the facility supports staff with tuition help if they are interested in gaining more qualifications. Vida Antwi, an RN, took advantage of these training opportunities.

Almer says another big problem is money. Hiring people, training them and increasing benefits to keep them, as his organization is doing, is expensive. He says the government is insisting on more staff but isn’t offering any funding to pay for them.

“We can do so much more if we had the economic support that we need,” he says, adding that Medicaid reimbursement rates aren’t enough to cover their costs, leaving them with an $80-per-day shortfall.

Almer says his nursing home doesn’t want to take on more patients than it can adequately care for, so it’s not operating at capacity right now.

Lori Smetanka is executive director of the National Consumer Voice for Quality Long-Term Care. She says, if anything, the new mandates on staffing and levels of care don’t go far enough.

“This new rule sets a floor or a baseline below which you cannot go, yet that is not to say that you shouldn't be higher,” Smetanka says.

But she says the rule is a good first step, since many nursing homes are so poorly staffed that those who live there are suffering.

“Residents are not getting the care and services that they need, and that's why they don't want to go to nursing homes,” she says.

Matt Perrin has seen this firsthand.

Perrin, who writes a weekly newsletter for family caregivers, lost his mom two years ago. She was in her 70s and living with dementia. After spending down her savings in a memory care facility, she spent the last six months of her life in several different nursing homes in Massachusetts. He says staff were kind and doing their best.

“But they were set up to fail, in my opinion,” he says. “That fact is really close to the wound that’s healing in my heart based on how the end of my mom’s life went, how the last six months went.”

He says the staff had too little training in dementia care. This led to problems as his mother struggled to find her way around and communicate.

He says instead of approaching her from the front and asking for permission to touch, nursing aides would approach her from behind to redirect her. She was shocked and would lash out. More than one nursing home told Perrin his mother — a retired nurse herself — was “non-compliant.” She twice ended up on a psychiatric ward before starting at another facility. He says all this was a big change from her relative contentment while living in memory care.

At the final nursing home where she lived, he says there was just a handful of employees per shift for around 50 residents, many with dementia.

“They just didn’t have the time to lean into each of the people under their care, as people,” Perrin says.

He says the new rule on staffing levels can’t hurt. But he believes more changes are needed in long term care to ensure people like his mother can live and die with dignity.