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Staffing shortages grow in North Carolina's nursing homes

Staff have continued to leave nursing homes around North Carolina, leaving vacancies that administrators find difficult to fill.

More nursing homes are reporting staffing shortages in North Carolina than at any other point in the coronavirus pandemic, according to a WFAE analysis of data published this month by the Centers for Medicaid and Medicare Services.

The data, collected during the first week of March, surveyed the state's 427 licensed nursing homes. Of those, 403 responded to questions related to staffing.

More than 42% of responding nursing homes — or 171 total — said they were experiencing shortages in at least one of four critical areas: nursing staff, clinical staff, clinical aides and other staff.

By comparison, 26% of responding nursing homes said they were short-staffed in at least one of those four areas a year ago. Some 28% said they were short-staffed in May 2020, when the government first began collecting the data.

As of this month, clinical aides and nursing staff appear to be in greatest need. Some 154 North Carolina nursing homes said they had a shortage of clinical aides, 142 said they needed nursing staff, 94 were short on other staff and 13 said they were short on clinical staff.

High turnover has been a problem in the nursing home industry for decades, said Cynthia Hancock, director of UNC Charlotte's gerontology program, but the coronavirus pandemic seemed to have exacerbated the problem to a level not previously seen.

"We've always had a problem keeping people in direct care work in nursing homes, but the fact that people are leaving and we're not able to back fill those positions is kind of a new, big challenge," Hancock said.

Nationally, the nursing home and residential care industry has lost roughly 392,000 workers since the start of the pandemic, which Hancock said has brought the workforce "back to where it was 15 years ago."

Concerns over pay, staff burnout

Many workers have been leaving because of burnout or opportunities for higher-paying jobs elsewhere, according to a survey conducted in January by the North Carolina Health Care Facilities Association.

The survey also found that 91% of nursing homes in the state have raised hourly pay, 97% are paying shift bonuses and 95% are using recruitment and retention bonuses.

However,84% of responding nursing homes said vacancies have persisted because they've received little to no applicants.

That could be because nursing homes are competing with national retailers and private health care systems that have also raised wages during the pandemic, with many offering $15 an hour or more for entry-level positions that require little to no training.

As of 2020, the median hourly pay for direct care workers in North Carolina was $11.91, according to PHI National, a policy research group focused on long-term care.

Many nursing homes simply may not be able to match $15 an hour, especially those that are heavily dependent on Medicaid funding. Hancock said those facilities may not be able to substantially raise wages unless state or federal lawmakers decide to increase Medicaid reimbursements and, in turn, provide more money to the facilities.

Change in culture needed

Hancock said those lawmakers and industry leaders need to consider how to help nursing homes become more attractive for potential and current employees to help solve the staffing crisis.

"We need to create a culture where people want to come to work," Hancock said. "Part of that includes fair pay, opportunities to advance, being trained well so you feel confident in the environment in which you're in, and not feeling like you're just a cog in the wheel."

If not, the staffing shortages could continue to worsen, especially as remaining workers are asked to take on more responsibility to make up for vacant positions and in turn experience more burnout.

According to the North Carolina Health Care Facilities survey, 98% of nursing homes in the state have been using overtime and double shifts and have asked employees to work overtime or take extra shifts.

Nearly half — 49% — of nursing homes also said they were keeping their facilities below capacity because of staff shortages, and 10% had placed a hold on accepting new admissions.

Hancock also said she believed workers should be given more say in decision-making at nursing homes, and that society at large should place more value on those working in elder care, especially in nursing homes and assisted care facilities.

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Nick de la Canal is an on air host and reporter covering breaking news, arts and culture, and general assignment stories. His work frequently appears on air and online. Periodically, he tweets: @nickdelacanal