An overwhelmed healthcare workforce, the implications of ongoing shortages and fears about a stressed pipeline took center stage during a Senate Health, Education, Pension & Labor Committee’s committee hearing Thursday.
While testimony did not specifically focus on nursing homes, several senators and witnesses raised labor solutions providers have said will be key to recovery in long-term care — among them immigration reform, nurse training and targeted attention for the direct care workforce.
“Our country is perilously short of nurses and those we do have are often not working in the settings that could provide the most value,” testified Sarah Szanton PhD, RN, dean of the Johns Hopkins University School of Nursing. “The average age of nurses today is 54 years old, and 19% of them are 65 or older, so you can imagine we’re worried about the future as well, coupled with an aging population that has more and more chronic conditions.”
Szanton and others noted that, despite rebounding interest in nursing education, access to training and testing programs has been limited by a lack of nursing faculty, clinical preceptors and proctors. COVID-related educational delays among recent graduates also have left some candidates for nursing positions less ready for the job, noted a health economics expert who cited declining pass rates.
Staff shortages have hit nursing homes particularly hard. Nursing facilities have lost more than 200,000 nurses and aides since the start of the pandemic, according to federal labor statistics. While other sectors have essentially returned to pre-pandemic staffing levels, nursing homes have fallen far short.
Increasing access and affordability to nurse training programs was a major theme of Thursday’s more-than two-hour hearing. Sen. Tim Kaine (D-VA) also raised specific concerns about bolstering the direct care workforce, which he said was often left out of conversations about broader healthcare shortages.
“Direct care professionals make an average of $11.75 an hour. They’re some of the lowest paid workers in the economy, but they provide difficult, hands-on care to seniors and people with disabilities,” Kaine said. “And this workforce shortage kind of compounds other workforce shortages. I go to hospitals and they say, ‘We have to keep people longer because the direct care workforce shortage means there’s no placements where we can discharge someone from a hospital to a long-term care setting or to appropriate home healthcare.’”
Immigration gets fresh attention
While several senators used the hearing to pitch training and education bills they planned to introduce this session, Sen. Bill Cassidy, MD, (R-LA), the ranking committee member, said he wanted to see something that would pay off “relatively quickly.”
Immigration “would be huge,” said Cassidy, who also spoke about improving medication-assisted therapy options to relieve pressure on hospitals.
“Frankly, we need to encourage immigration,” agreed James Herbert, PhD, president of the University of New England. “In a state like Maine, where we are losing native population, the only way our population is staying stable and even growing is through immigration.”
Maine has seen several nursing homes close since 2021, with some providers blaming lack of affordable housing in rural and touristy areas.
Sen. Mitt Romney (R-UT) noted that, typically, nearly 20% of nurses and medical professionals in this country are foreign-born. But those trying to get here since the pandemic started have largely been blocked from helping the US address “desperate” healthcare needs.
“The backlog of medical professionals that want to come into this country has become enormous. We require them to be interviewed … but apparently the state department is still so concerned about COVID that they’re not interviewing people,” Romney said. So in places like the Philippines, where there are some 30,000 people who want to come here and serve as nurses, we can’t get those nurses in.”
He added: “If we have a nursing shortage and a doctor shortage, let’s let those who are in line, that are qualified, come here.”
Congress last year let die several immigration bills that had been backed by long-term care advocates.
In a statement submitted to the Senate committee ahead of Thursday’s hearing, LeadingAge called on members to support workforce policies that would “establish and retain a pipeline of foreign aging services workers, and support the enactment of a temporary guest worker program for aging services providers, and improve the process for allowing registered nurses to permanently enter the US.”
The organization also recounted the efforts of Sanford Heath and the Evangelical Lutheran Good Samaritan Society to hire 500 international nurses, as their hospitals also battled this healthcare staffing crisis. Good Sam leaders have told McKnight’s that, although hundreds have committed to working for the system since 2021, only a few have trickled in.
Exhausted but looking ahead
In a statement issued before the hearing, the American Health Care Association / National Center for Assisted Living cautioned against trying to fill positions through increased regulation.
“The pandemic has taken a physical and emotional toll on our healthcare workers, especially our nation’s long-term caregivers,” Mark Parkinson, president and CEO of AHCA/NCAL, said. “Even after taking unprecedented steps to support our workforce, nursing homes have experienced the worst job loss of any healthcare sector.”
A recent AHCA survey found that 84% of providers are still facing moderate or high levels of staffing shortages. At that pace, AHCA predicts nursing homes won’t see a return to pre-pandemic workforce levels until 2027.
“An unfunded federal staffing mandate, as has been proposed, will only make the situation worse. What is needed instead are meaningful investments and programs that will help nursing homes compete for caregivers, address nationwide nursing shortages, and ensure we have a strong workforce for a growing elderly population. We stand ready to work with Members of Congress on comprehensive solutions that will better support and strengthen the long term care workforce.”
LeadingAge also asked the committee to implement what it calls “common sense proposals” before the Center for Medicare & Medicaid Services enacts its mandate. The organization laid those out in a letter to Congressional leaders earlier this month.
In addition to its staffing mandate and immigration asks, the association for nonprofit aging services providers also encouraged the committee Thursday to consider policies that would:
1. Bolster wages for aging services professionals
2. Offer incentives and federal grants to expand training and advancement opportunities, specifically those that hold promise for aging services professionals
3. Mitigate temporary nurse staffing agencies price gouging
4. Enact meaningful, equitable long-term care financing
