Report: Nursing homes cope with huge staff shortages

Media Contacts

Massachusetts improving after crisis situation last spring


BOSTON –More than 3,000 U.S. nursing homes last month had a shortage of nurses, aides or doctors, the nadir for a crippling problem that started last May. At any given time throughout most of 2020, more than 200,000 Americans resided in nursing homes that admit they were suffering through staff shortages.

In Massachusetts, however, the trend of staffing shortages has been improving since May when 85 homes were understaffed compared to 10 in December.  But even seemingly small shortages in staffing can potentially affect the care of many. For example, 846 residents live in the 10 homes reporting shortages as of December 6th, 2020.

As the COVID-19 pandemic tore through the United States’ 15,000 nursing homes and our country as a whole last year, the number of understaffed homes increased from May to December, according to “Nursing home safety during COVID: Staff shortages,” an analysis of government data by U.S. PIRG Education Fund and Frontier Group. Our report also shows that:

●     In Massachusetts, 2.2 percent of homes reported a shortage of nurses by early December, and 2 percent reported a shortage of aides. Those numbers are down since May when 19.6 percent reported shortages of nurses and 22.6 percent reported shortages of aides. 

●     Nationwide, 23 percent of homes reported a shortage in at least one staff category: nurses, aides or clinical staff.

●     Shortages of aides were the most widespread problem nationwide, affecting 20.6 percent of nursing homes in December, up from 17.4 percent in May.

●     Shortages of nurses were almost as bad, affecting about 18.5 percent of homes in December, up from 15 percent in May.

●     The number of homes with a shortage in at least one staff category increased to 3,136 in December, up from 2,790 in May.

“For Massachusetts, this is a good news, bad news, and cautionary news story. The good news is that nursing home staffing across our state has improved significantly since May, bucking the national trend. The bad news is that we had far more staffing shortages than most other states in May, also bucking the trend,” said Deirdre Cummings, MASSPIRG’s consumer program director. “The cautionary story is that we must continue to measure, improve and build on the set of nursing home reforms adopted in September that appear to be having a positive impact on staffing in nursing homes.”

“Staff shortages at nursing homes are a huge problem that has new importance in the COVID-19 era. Overstretched staff may deliver worse care, be more likely to bring virus to a facility, and also have very difficult work conditions. We have no built-in backstop for this essential part of the health care workforce,” said Michael Barnett, M.D., Assistant Professor, Health Policy and Management, Harvard T.H. Chan School of Public Health. “Bolstering this workforce should be a policy priority moving forward.”

Our research also shows that nursing homes are still trying to overcome shortages of personal protective equipment (PPE). After these shortages improved during the autumn versus the August numbers mentioned in our first report on nursing homes, they got worse in December.

In the new report, U.S. PIRG Education Fund is calling for several policy actions to improve the situation in nursing homes.  That would require approving money in a new federal COVID relief bill to buy more PPE and tests; hire more staff; and pay hazard pay, higher wages or bonuses to ensure optimal staffing levels through the end of the pandemic.

“This PIRG report contains important new national data on a nursing home industry clearly in transition,” said 1199SEIU Executive Vice President Tim Foley. “As the pandemic has exposed, sufficient direct care staffing is critical to ensure strong infection control standards and to ensure quality resident care. The improvements that the report shows in staffing levels over the last few months in Massachusetts are certainly welcome and they reflect important 2020 state policy reforms and large increases in state funding of nursing homes.  However, additional reforms remain necessary, particularly as nursing homes’ census rebounds post-pandemic. It is time to enact reforms that are centered on a better workforce including the creation of a CNA pipeline, lifting the wages and benefits of workers, and deepening the engagement workers in the care team planning process. This is how we honor the heroes on the frontlines and protect the seniors and people with disabilities in their care.” 

“Staff and PPE shortages in nursing homes existed before the pandemic, but the coronavirus exposed the threats to the lives of residents, staff, and the community that these shortages pose. We must adopt permanent plans to keep our parents and grandparents in these residences safe during — and after — the pandemic,” said Cummings.

The staffing and PPE shortages are just two of the problems that U.S. PIRG Education Fund found by mining Medicare and Medicaid data on nursing homes. We will explore more of these issues in a series of reports in the months ahead.

Click HERE for our guide: “20 questions to ask your nursing home during COVID.”


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