Long Term Care & Senior Living Blog

Economics 101: The Senior Care Staffing Shortage

Irene Fleshner

Staffing shortages in long term post-acute care faciltiesLong term post-acute care facilities across the country face staffing shortages due in large part to high turnover rates, a lack of training and advancement opportunities, and a workforce largely comprised of individuals who have multiple job options. It's a problem that I and many of my colleagues deal with on a daily basis, and it leaves many facilities in a constant state of workforce flux. Now, imagine combining our shortage of workers with a sharp increase in demand for those same workers. We’d have a true crisis on our hands.

As scary as it is to imagine, this is exactly what we have coming.  I recently read a study from the Philip R. Lee Institute for Health Policy Studies at UCSF that estimates demand for long-term care workers will grow by 2.5 million by 2030. As we all remember from Economics 101, combining high demand with short supply causes scarcity — and scarcity leads to high costs, unfilled needs, and fierce competition for resources. So, how do we ensure that our aging population gets the care it needs without bankrupting everyone involved in the process?  I have a few thoughts:

Increase the supply of caregivers - No matter what else we do; the country will need more caregivers.  There’s no way around it — the current supply of long-term care workers will not meet the need of future populations.  And we don’t need a study to tell us that. Heck, the current supply of workers doesn’t even meet the needs of the current population!  We as a country must invest in developing more nurses, certified nursing assistants, social workers, therapists and home health caregivers. If we’re going to attract more talent, we must invest in educational and training activities and elevate the status of our workers.

Give our workers more without paying them more money - As I like to say, people don’t quit bad jobs — they quit bad bosses. Long-term care has a reputation for high churn among employees, and I think we're all partially to blame for that. There tends to be little respect or appreciation shown to workers, and all-too-often they’re treated as unskilled commodities, easily replaced by "someone who has a better attitude.” Increasing job satisfaction will go a long way toward both retaining existing workers as well as increasing the number of people who look to enter the field. We, as leaders, need to praise and acknowledge good employees and good work. We need to reward those who do their jobs well. We need to treat our employees like we actually want them to stay. Over my career, I've found very few recruitment initiatives that are more effective than a respectful and appreciative boss. 

Decrease the demand for caregivers - In addition to increasing the number of workers who want to work in this field, we can combat the shortage by decreasing how many we need.  There are many roles in long-term care that could be automated -- from medical records to senior care staffing and scheduling and supply chain management. By investing in processes and systems that remove humans from the equation, we'll be able to reduce the number of people we need to run our facilities -- and the number of errors we humans inevitably make.

We can also decrease our demand for caregivers by improving the health and independence of our aging population. Large-scale investments in wellness programs and dementia research can create a population of seniors who need less skilled, day-to-day care. "Old," doesn't have to be synonymous with "infirmed."


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Irene Fleshner

Irene Fleshner, RN, MHA, FACHE, serves as a Principal for Reno Davis & Associates and the Senior Vice President for Strategic Nursing Initiatives for Genesis HealthCare.


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