Government Leaders Update from HFAM

HFAM Government Leaders Update

Workforce Issues Remain Top Priority for Long-term Care

Friends,

The COVID-19 pandemic has spurred an unprecedented workforce crisis across the nation. This crisis has hit the long-term and post-acute care sector particularly hard.

Our national affiliate, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) released a report earlier this month showing long-term care facilities are suffering from the worst labor crisis and job loss than any other health care sector. Nursing homes alone have seen its industry’s employment level drop by 14 percent or 221,000 jobs since the beginning of the pandemic.

HFAM had the National Investment Center for Seniors Housing & Care (NIC) review Maryland specific workforce shortage data. In the research, it was found that Maryland labor participation rates are higher, and specifically in Maryland there is a 15 percent shortage of nursing staff compared to a national shortage of 20 percent.

Of course, workforce shortages in healthcare and long-term care specifically existed before the COVID-19 pandemic. However, the recent data shows that other parts of the healthcare continuum, such as physician offices, have regained workforce while long-term care continues to struggle due to not only the overall shortage of workers, but also because of the connection between Medicaid rates and wages, as well as the competition with hospitals and other non-healthcare employers.

Key Points on Workforce Data:

Interestingly, the BLS data analyzed specifically for Maryland shows that our labor shortage in Maryland is significant but less significant than the national shortage.

Note: The Maryland data run was from February 2020 to August 2021; AHCA’s national data was from March 2020 to October 2021.

The labor force participation rate is higher in Maryland than it is nationally.

Maryland’s nurse and all staff to patient ratio are slighter higher than the national averages, while the aide and tech ratio is slightly lower than the national average.

Vaccination PSA for Long-Term Care Employees

We are eternally grateful to Speaker of the Maryland House of Delegates Adrienne Jones, as well as Cherie Taylor and Renee Harris of the Hebrew Home of Greater Washington for recording this HFAM public service video to help encourage people living and working in skilled nursing and rehabilitation centers and on assisted living campuses to get vaccinated—and to get the booster!

Amid workforce challenges, direct care staffing agencies are charging exorbitant prices to long-term care facilities that need workers. These agencies are charging more than double and – in some cases – as much as quadruple the amount operators are currently paying their staff.

Based on a small sample of actual Medicare cost report data for skilled nursing and rehabilitation centers, hourly wages (excluding bonuses and shift differentials) have increased by five to seven percent, hourly wages for agency staff have increased by forty to fifty percent, and reliance on agency staff has gone up more than two and a half times.

In a small survey of HFAM members, representing 66 skilled nursing and rehabilitation centers across the state, we found that the percentage of agency staffing has increased from 4.8 percent in December 2019 to 24.33 percent in September 2021. Among these same centers, the average base hourly wage for RNs, LPNs, and CNAs has increased.

It is important to remember that all healthcare providers are competing for the same limited workforce. Amid the COVID-19 pandemic, it is not uncommon for hospitals to pay agency nurses between $160 and $275 an hour. Some hospitals are also paying thousands of dollars in signing bonuses.

At the national level, AHCA/NCAL sent a letter last month to Federal Trade Commission (FTC) Chairwoman Lina Khan requesting assistance with an anticompetitive practice with direct care staffing agencies. The letter asks that the FTC use its authority to investigate this price gouging and take appropriate action to protect skilled nursing and rehabilitation centers and assisted living communities.

While providers in states across the country are facing these same issues, only Massachusetts and Minnesota currently place caps on staffing agencies. Many states are trying for legislative fixes to prevent staffing agencies from charging exorbitant rates. For example, lawmakers in Pennsylvania are considering the introduction of legislation that would regulate temporary staffing agencies and set maximum pay rates for agency healthcare workers.

It is our understanding that services, including healthcare staffing services, are not included in the current Maryland anti-price gouging statute.

Together with members of the Maryland General Assembly and colleague leaders from other healthcare associations, we will work to change that, as well as on specific legislation to stop price gouging by medical staffing agencies.

In the meantime, skilled nursing and rehabilitation centers, assisted living campuses, and hospitals in Maryland and across the country are doing everything they can to recruit and retain workers, such as sign-on bonuses, wage increases, referral bonuses, gift cards, PTO, flexible scheduling, and additional training and education.

We appreciate the opportunity to bring this important issue to your attention and look forward to our work together on solutions. In the meantime, should you have any questions, please do not hesitate to contact me at jdemattos@hfam.org or Hope Morris at hmorris@hfam.org.

Be well,

Joe DeMattos

President & CEO

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