By Steve Moran

AHCA/NCAL just released the results of a survey about staffing in nursing homes and assisted living communities. It is really ugly.

  • 86 percent of nursing homes and 77 percent of assisted living providers said their workforce situation has gotten worse over the last three months.
  • Nearly every nursing home (99 percent) and assisted living facility (96 percent) in the U.S. is facing a staffing shortage. 59 percent of nursing homes and nearly one-third of assisted living providers are experiencing a high level of staffing shortages.
  • More than 7 out of 10 nursing homes and assisted living communities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff.
  • Due to these shortages, nearly every nursing home and assisted living community is asking staff to work overtime or extra shifts. Nearly 70 percent of nursing homes are having to hire expensive agency staff. 58 percent of nursing homes are limiting new admissions.
  • 78 percent of nursing homes and 71 percent of assisted living facilities are concerned workforce challenges might force them to close. More than one-third of nursing homes are very concerned about having to shut down their facility(ies).

You can access the full survey HERE.

The Industry Solution

The AHCA/NCAL solution is government intervention as proposed by t and LeadingAge by using the current budget reconciliation process. They have laid out their vision of how the government can help in the Care for Our Seniors Act.

“Congress has the opportunity right now, through budget reconciliation, to include meaningful investments in long-term care, which will help address key staffing challenges. Our caregivers are the backbone of long-term care, and they deserve the full support of our lawmakers. We cannot allow facilities to close because of these challenges, which will directly impact residents and their families, especially when lawmakers have the means to help solve this dire situation” – Mark Parkinson, president and CEO of AHCA/NCAL.

Argentum has also been pushing hard for the release of PPE funds, but calling for help paying higher wages is falling under the category of risky business when it comes to private-pay senior living because it also invites federal regulation. Something most senior living operators want nothing to do with after seeing the burden it has created for nursing homes.

But What if It Doesn’t Happen?

Historically, when the nursing home staffing pay hits a crisis point, the federal government steps up to the table with just enough money to keep nursing homes’ noses and mouths above water. But never enough to make a substantial improvement in staffing levels and quality of care.

It is hard to know for sure and might be worth some research, but it likely ultimately costs the federal government buckets more money. Because barely adequate care means more frequent, more severe, and MORE EXPENSIVE hospitalizations.


I have no criticism of what LeadingAge & AHCA/NCAL is asking for. It is right and reasonable. It would make the lives of older people and those who serve them much much better. I am also far from convinced that we will see meaningful progress in the immediate future.

Right now, the federal government is simply fighting bigger battles that are arguably less worthy but are more visible.

A Fixable Problem . . . Sort Of

There are, right now, senior living communities, not just communities but organizations, that are doing just fine with staffing. They have all their positions filled or nearly so. When they need to fill a position, it takes some work but they are making it happen. All, or nearly all, their team members love coming to work each day.

Don’t get me wrong, it is hard and things are always getting off track. It is a constant process of course correction. It is the most important job a leader has. It consists of three things:

  1. The leader’s vision for the organization – At Senior Living Foresight, our mission is to help leaders lead better. The mission is not just words though. We get to see that this is true and we hear from readers like you.
  2. How the leader thinks about team members – Do they want what is best for the team members, professionally and personally? Or is it all about the organization?
  3. How the leader thinks about their customers (residents & family members) – More than anything else, what makes Jeff Bezos the wealthiest person in the world and a great leader is that he is maniacal about the customer experience.

The way this all gets pulled together is by great leaders doing lots of little things that make their organization better for teams and better for customers.

We just put together a list of 100 things you can do tomorrow to lead better (which you can ACCESS HERE). Try some of them, let us know how it goes.

Be Careful What You Wish For

You may still be thinking “if only I could pay more money . . .” While we need to figure out a way to make this happen IT WILL NOT SOLVE YOUR CULTURE PROBLEM. It will simply make bad team members more reluctant to leave your organization.