Tight Labor Forces Nursing Homes, Others to Forgo New Patients

A lingering labor shortage due to Covid-19 is forcing nursing homes and home health agencies to turn away new patients even as the once-surging omicron variant is in retreat.

Seniors discharged from hospitals wait longer and travel farther for nursing home recovery beds, as many facilities shun new admissions, including patients with more complex problems whose care would strain their depleted staffs.

Home health agencies that can’t afford costly temporary staffing help must also turn away new referrals and the valuable revenue they provide.

The situation creates a bottleneck for patients waiting to leave crowded hospitals for the proper post-acute care setting. It’s also limiting hospitals’ ability to admit new patients as they struggle with their own staffing woes.

“When you’re not able to move patients out of the hospital quite as quickly, it means you can’t move patients into inpatient beds quite as quickly as you might want either,” said Akin Demehin, policy director at the American Hospital Association.

‘Wide Net’

Quality Life Services operates 10 nursing homes in Pennsylvania with just over 1,000 beds. From November 2021 through January 2022, they received nearly 3,500 patient referrals, mainly from hospitals.

“We had to deny, strictly because of staffing challenges, 24% of those referrals; 832 of them, we had to say ‘no’ strictly because we don’t feel we have the appropriate staff to be able to care for them,” said Mary Susan Tack-Yurek, the company’s chief quality officer.

Patient referrals are up 45% during the pandemic because discharging hospitals “are forced to cast such a wide net,” she said. “None of us can accept these patients.”

The nursing home industry added 2,100 jobs in January, the first monthly job growth since July 2019, according to the American Health Care Association and National Center for Assisted Living. But facilities have still lost 238,000 positions, about 15% of their workforce, since the pandemic began.

Labor shortages at Bethel Home & Services, a nursing home in rural Viroqua, Wis., have forced the facility to steadily decrease its patient capacity. The company plans to halt all nursing home services when its remaining 14 residents can be placed elsewhere, said CEO Debra Stout-Tewalt.

“There’s a lot of competition for the skilled staff,” she said. “Those RNs and those LPNs, it is extremely difficult for us to even get applicants.”

Travel Nurses

Bethel uses temporary “traveling nurses” to fill vacancies, but the cost is prohibitive. “We’re paying one traveling nurse over $100 an hour to help us cover our schedule. So it’s a very challenging situation for us,” Stout-Tewalt said.

Travel nurses aren’t attached to a particular facility and work on short-term contracts. They’re paid two to four times what regular staffers make.

Both the American Hospital Association and the AHCA/NCAL have asked the Federal Trade Commission to look into anti-competitive and unfair practices related to possible price gouging by health-care staffing companies. Nearly 200 House members, led by Reps. Peter Welch (D-Vt.) and H. Morgan Griffith (R-Va.) asked the White House to look into the matter as well.

States are beginning to take an interest as well. In Maryland, Senate Bill 565 and House Bill 800 would prohibit “an essential good or service” from being sold during a state of emergency for more than 10% of its pre-emergency price. Both proposals have been referred to committee.

AHCA/NCAL projects contract labor costs will jump 106% for most nursing homes in 2022. Nationally, that’s about $131,000 per building, in addition to rising staff labor costs.

Home Health

One option for some patients getting out of the hospital is receiving additional care at home, but home health agencies are equally stretched, according to William Dombi, president of the National Association for Home Care & Hospice.

Dombi said a board member of a national home health provider told him that 9%, or 2,700 of their roughly 30,000 U.S. employees, were out one week in January due to Covid infection or quarantine. “It seems the larger you are, the bigger the shortages.” Dombi said.

The situation is fluid. “A home health agency could say ‘yes’ today,” to accepting new patients “and ‘no’ tomorrow. And then ‘yes’ again next week, but ‘no’ again next week, too,” Dombi said