You’ve likely noticed “now hiring” signs in storefronts and businesses across town. The U.S. unemployment rate was just 3.6 percent in May 2022, according to the Bureau of Labor Statistics. While low unemployment is encouraging, it also reveals a downside that is especially acute in the senior living and long-term care sector.
Recent surveys from the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) show that most long-term care providers continue to struggle with moderate to severe staffing shortages even as the pandemic’s acute phase recedes. Many facilities are also reporting significant financial losses. These combined pressures raise important questions about future availability and quality of care for older adults, whether in senior living communities or receiving care at home.
>> Related: What’s the Difference Between Assisted Living and Nursing Care?
Assisted living faces troubling staffing shortfalls
Assisted living communities provide housing, personal care, and limited nursing services. Residents typically need help with one or more activities of daily living (ADLs)—bathing, dressing, eating, toileting, transferring, and continence—and often receive assistance with instrumental ADLs (IADLs) such as household tasks. Assisted living services may be provided in community settings or in a person’s private home.
NCAL, the assisted living division of AHCA, represents thousands of assisted living communities nationwide. A recent NCAL survey of 120 assisted living providers revealed several concerning trends:
- More than half (52 percent) report that their overall workforce situation has deteriorated since early 2022.
- About 63 percent are experiencing staffing shortages, and roughly a quarter of those report a high level of shortage.
- Nearly all providers (93 percent) have increased wages in an effort to attract and retain caregivers.
- Almost all (98 percent) are asking existing staff to work overtime or extra shifts; half have relied on temporary agency staff.
- 87 percent say hiring new staff is difficult, and 90 percent cite a lack of interested or qualified candidates as a top obstacle.
- Nearly half (48 percent) worry they may have to close if workforce challenges persist.
- Operational costs have risen substantially—an average increase of about 40 percent year over year.
- More than one-third (37 percent) are operating at a loss, and 35 percent say they cannot sustain current operations for more than a year.
>> View the full results of the NCAL assisted living survey.
Nursing homes are also short-staffed and financially strained
Nursing homes, or skilled nursing facilities, provide a higher level of medical and rehabilitative care than assisted living communities, with 24/7 nursing services. Residents often require help with ADLs and IADLs; some remain long-term due to chronic conditions, while others receive short-term rehabilitation after surgery or hospitalization.
AHCA represents more than 14,000 nursing homes and long-term care providers across the U.S. Their survey of 759 nursing homes highlights similar, and in some cases more severe, challenges:
- Six in ten providers (60 percent) say their workforce situation has worsened since January.
- 87 percent face moderate to high staffing challenges; 48 percent report a high level of shortage.
- Nearly all (98 percent) report hiring difficulties; 99 percent are asking staff to work overtime, and over 70 percent have turned to agency staff.
- Most providers have raised wages (95 percent) and offered bonuses (92 percent) to compete for workers.
- Seventy-one percent identify a lack of interested or qualified candidates as their primary hiring barrier.
- Staffing constraints have forced 61 percent to limit new resident admissions.
- Seventy-three percent worry their facility could close because of workforce shortages.
- Financial limitations hinder competitive pay for many providers—76 percent cite lack of funding as a barrier to offering market wages.
- Costs have climbed by an estimated average of 41 percent year over year; 59 percent report operating at a loss, and 53 percent say they cannot sustain current operations for more than a year.
>> View the results of the AHCA nursing home survey.
Multiple causes behind an expanding problem
The staffing crisis in long-term care stems from several overlapping causes. The COVID-19 pandemic exacerbated existing weaknesses, but many challenges predate the pandemic. Care roles in assisted living and skilled nursing often pay low wages, require long hours, and carry significant physical and emotional demands. As the labor market tightened and wages rose in other sectors, many low-skilled workers found alternative employment that offers comparable pay with fewer demands.
At the same time, many experienced long-term care workers have reached retirement age. The difficulties and risks associated with pandemic-era care settings prompted some to retire earlier than planned. These losses reduce the pool of experienced staff just as demand increases: the large Baby Boomer generation is aging, and more people are beginning to need long-term care services. Fewer caregivers and more potential residents create a compounding pressure that threatens the stability of the sector.
>> Related: A Low-Wage Paradox for Assisted Living & LTC Caregivers
Wider consequences for older adults and families
Even if you believe you won’t need institutional care, the staffing shortage likely affects you or someone you love. According to the Administration on Aging, roughly 70 percent of people over 65 will need long-term care services at some point—help that often involves assistance with at least two ADLs. Some will need the higher level of care offered in nursing homes, while many others will rely on assisted living or home-based care.
In-home care is not immune: home health aides and personal care workers are also in short supply and increasingly costly as agencies, employers, and private households compete for the same limited workforce. This makes staying at home more expensive and harder to arrange for many seniors.
Our nation faces a mounting long-term care challenge that requires coordinated action. Government, the private sector, advocacy organizations, and families must work together to develop sustainable solutions that meet the care preferences of an aging population. Equally important is supporting the well-being—physical, mental, and financial—of caregivers, both paid and unpaid. Addressing these issues is urgent if we want to preserve access to safe, reliable care for current and future generations.