"To say the sector has been hard hit has been an understatement. It's now a more dangerous place to work, and people understand that. I'm not surprised people are worried about going into nursing homes," said Anne Montgomery, co-director of the program to improve elder care at Altarum, a not-for-profit health research and consulting organization.
Yet demand continues to climb. Despite more potential residents choosing home care during the pandemic, the aging population in the U.S. and a pent-up demand for rehabilitation after postponed elective surgeries create a need for staff that nursing homes just can't fill. Some are even halting admissions because they don't have the staff to care for more residents.
"Really, we just have a great demand, an incredible demand in this workforce," Montgomery said. Long-term care is one of the top three industries in terms of projected growth, she said.
"The jobs are certainly available," Shamberg said.
During the pandemic, nursing homes have had to get creative. With the help of federal funding, some have been able to provide hazard pay to workers, offer overtime to cover shifts and train some new workers. CMS last year issued a waiver that allowed nursing homes to employ temporary nurse aides for longer than four months, instead of requiring additional certification, to help in the direct care of residents.
But experts fear that once the pandemic ends, workers will leave the industry, driven by the stresses of the job.
In August 2020, the Pennsylvania Health Care Association found in a survey of members that workers are burned out, exhausted and fatigued, sentiments reflected by healthcare workers nationwide.
"Even though the vaccine is here, and even though it is being distributed, you have a lot of staff that could potentially leave after everything," Shamberg said. "Our biggest fear is what will happen when the dust settles. … There is the very real fear there could be a mass exodus from long-term care."
Loosening regulations on training, such as allowing blended in-person and online training, could help attract more workers and increasing Medicaid and Medicare reimbursements would give providers more funds to reinvest in workers, Shamberg said.
"Long-term care has really been in the spotlight. A lot of the flaws and the shortcomings have really been exposed," Shamberg said. "It's a broken system right now."
Montgomery said that the pandemic, for all of its negatives, has helped raise the profile of long-term care workers in the public eye, which could help drive demand for better funding and conditions, such as better staffing ratios or a living wage, for those workers, either privately or through federal assistance.
"I think that message is starting to translate," Montgomery said. "That doesn't mean it will change the picture quickly."