The Growing Shortage of Nurses

Is it possible to run short of nurses? What would that look like? And how would their scarcity impact pre- and recent-retirees who have enjoyed lifelong easy access to adjunct healthcare staff?

Unfortunately, all you have to do is look around you today, especially in the large but increasingly shaky long-term care industry. This “final destination” for the infirm elderly is already chronically short of nursing staff. According to McKnight’s News Service, 63 percent of facility nursing directors say they don’t have enough staff for proper care.[16] Patients can be turned away, face substandard (even neglectful) care, or ultimately be forced to move when facilities close their doors.

And unfortunately, there are no easy solutions. Investment performance, estate planning, even insurance can’t help if care becomes scarce or unavailable.

The best solution may soon become the only solution. Retirees need to plan creatively to AVOID chronic disease rather than just pay for it. Lifestyle and even dietary changes, especially those that minimize cancer, diabetes, dementia, and cardiac issues, should be strongly considered.

What’s happening to the nurses?

Since the early 2000’s, many projections of the need for Registered Nurses (RN) showed large shortfalls in the coming 30 years. Dire warnings [1] circulated in the industry press that the existing nursing workforce could not be replaced in time, resulting in severely diminished care quality. Contributing dynamics included burnout due to overwork, depressed pay and benefits, poor working conditions, the difficulty of recruiting and training new nurses at the needed pace, and an aging population increasing the need for nursing care.

The educational bottlenecks included lack of nursing schools in many high-growth locales and a frequent lack of sufficient faculty to increase graduate output. Nursing candidates still face long waiting lists for school entry, with the only alternatives being a long commute, or relocation to a school with openings.

Since 2000, the number of alternative professional options within healthcare available to potential nursing candidates have increased. This includes many job classes that pay well while avoiding the war zone intensity of many large-hospital nursing positions.[2] Working conditions, including highly variable relations with physicians and administrators, and compensation issues have discouraged nurses of all ages and experience levels. The result is that recruiting and retaining nurses, long term, isn’t as easy as in previous decades.

Fortunately, despite these dynamics, recent new and expanded educational programs, and attention to basic workplace experience have begun to turn the tide, particularly since 2016. The number of new nurses is getting closer to the projected need.[3]

Mostly.

Where you live may impact the level of care available to you

Some states, and particularly rural counties and towns are still short of nurses. And solutions are elusive.

One popular strategy – recruiting and literally importing nurses from outside the U.S. – doesn’t always work in these areas and working-age natives often go elsewhere seeking better economic opportunity.[3]

And even in areas where trained nurses are available, there are still “nursing gaps” In certain care setting.

Not every nurse, or nurse’s assistant, wants to work in a long-term care facility. Even in major metropolitan areas, hospitals may run fully staffed while nursing homes struggle to fill important positions.[4]

The Long Term Care industry, which is becoming increasingly important with the aging population, is nurse-intensive in all settings: in-home, adult day care, assisted living, and skilled nursing facilities. Since most extended care in these environments is not physician-supervised (doctors are often only on call or present for limited hours), the nurses and nursing assistants are the primary front-line staff. Responsibility is heavy, often with little backup. Especially after normal business hours.

The widening long-term care pay gap is increasing the nursing gap

Compensation issues dominate the Long Term Care landscape.[5]

Retirees of all ages should know that the Long Term Care industry, particularly the skilled nursing facility sector, runs on paper-thin margins and that’s on the good days. Skilled nursing is one of the most heavily regulated businesses in today’s economy, with assisted living not far behind. Compliance and liability costs far exceed the norm.

Another little known Long Term Care financial dynamic is that over half (62 percent) of all long term residents in nursing homes are funded by Medicaid.[6] However, Medicaid “reimbursements” for each resident tend to fall short of actual costs by up to $63.71 per day.[7] While some facilities can recover a portion of this by charging higher fees for their private-pay beds, it is rarely enough to stay in the black.

Low-income area facilities, where the majority of beds are paid for by Medicaid, regularly lose money. More and more of these facilities close every year, despite the growing “potential resident” population.[8,9]

In this environment, competitive pay for RNs and Certified Nursing Assistants is hard to come by and it shows. Staffing and retention are the number one issues in industry press and have been for several years. Articles are constantly circulated that explore how to recruit, retain, and “engage” staff–but mostly tiptoe around compensation.

Many nursing assistants live below the poverty line, relying on Food Stamps and Medicaid just to get by.[10]

It’s little wonder that these jobs are hard to fill.

The Impact on most retirees: fewer choices, higher costs, lower quality

Long Term Care is already critically expensive putting it of out reach for most middle-income Americans. The list below shows the national averages today and in just 15 years assuming 3 percent inflation [11]:

• Assisted living facility: $48,000.00, rising to $74,782.00
• Skilled nursing-shared room: $89,297.00, rising to $139,122.00
• Skilled nursing-private room: $100,375.00, rising to $156,381.00

How might the increased scarcity of staff, or rising wages, affect these costs? These numbers are based on current pricing models and availability. At the current rate of nursing home closure, retirees may find availability of skilled nursing care reduced by up to 60 percent.[8] As facilities become scarcer (as well as more crowded and further away from family) costs could far exceed these projections.

The quality of care is also becoming an increasing issue.

Those lucky enough to use today’s care facilities can face substandard care due to chronic staff shortages and the increasing presence of under-educated, subsistence-level workers in this presumably “safe” professional healthcare environment. Petty crime (or worse) against residents is a constant issue, cropping up even in well-established facilities.[12,13]

These issues are already reducing the number of filled beds (or “census”) in skilled nursing facilities. Ten or fifteen years from now it’s not hard to imagine that despite the growing population of aging baby-boomers, traditional Long Term Care resources will become increasingly scant – especially Medicaid-funded options.

One Solution: Avoid the need for Long Term Care

No one wants to “gray out” in a nursing home, but many of us do and more of us take it for granted that this will happen.

That is, we simply accept that chronic, debilitating disease is an expected final phase of our lives.

We overlook the fact that the primary conditions driving most residents into skilled nursing are “diseases of lifestyle:” type II diabetes; cardiovascular disease, dementia, and cancer.[14,15]

Forward-looking retirement preparation needs to START with lifestyle changes that avoid or combat disease. Diet and exercise can easily be aligned with vigorous advanced age. The Paleo Diet^® removes foods and additives that have been linked to chronic disease and replaces them with longevity-enhancing vegetables, fruits, and lean meat.

It is a legitimate fighting chance to stay out of care facilities.

REFERENCES

1. Grant, Rebecca. “The U.S. Is Running Out of Nurses.” The Atlantic, 3 Feb. 2016, https://www.theatlantic.com/health/archive/2016/02/nursing-shortage/459741/.
2. Whiteside, David. “More Doctors than Nurses … in 20 Years or Less.” David Whiteside: https://www.davidwhitesidecopywriting.com/single-post/2017/02/05/More-doctors-than-nurses.
3. Howley, Elaine K. “Is there a coming nursing shortage of nurses?” U.S. News and World Report, 28 Nov. 2018, https://health.usnews.com/health-care/patient-advice/articles/2018-11-28/is-there-a-coming-shortage-of-nurses
4. Thew, Jennifer, RN. “5 Things You Should Know About the Nursing Shortage.” | HealthLeaders Media. https://www.healthleadersmedia.com/nursing/5-things-you-should-know-about-nursing-shortage.
5. Stempniak, Marty. “Big Rise: More than 43,000 Jobs Open in Long-Term Care as Leaders Plot – News.” McKnight’s Long Term Care News, 31 Jan. 2019, https://www.mcknights.com/news/big-rise-more-than-43000-jobs-open-in-long-term-care-as-leaders-plot/.
6. “2018 Long-Term Care Statistics | Medicare/Medicaid Consultants.” Long Term Care Consulting Services | Medical Billing and Business Management Solution For Skilled Nursing Facilities, 3 Oct. 2018, https://www.Long Term Carecs.com/blog/long-term-care-statistics-2018/.
7. Hansen, Hunter & Co. PC. “A report on shortfalls in Medicaid funding for nursing center care,” prepared for the American Health Care Association. Nov. 2018. https://www.ahcancal.org/facility_operations/medicaid/Documents/2017%20Shortfall%20Methodology%20Summary.pdf
8. Nursing Home Closures: The Elderly Population Is Exploding, Yet Nursing Homes Are Closing – Assisted Living Today. 27 Sept. 2011, https://assistedlivingtoday.com/blog/nursing-homes-closures/.
9. Healy, Jack. “Nursing Homes Are Closing Across Rural America, Scattering Residents.” The New York Times, 4 Mar. 2019. NYTimes.com, https://www.nytimes.com/2019/03/04/us/rural-nursing-homes-closure.html.
10. Covert, Bryce. The Workers Caring For Our Grandparents Are Paid Poverty Wages. https://thinkprogress.org/the-workers-caring-for-our-grandparents-are-paid-poverty-wages-30047ff8b474/.
11. Cost of Long Term Care | 2018 Cost of Care Report | Genworth. https://www.genworth.com/aging-and-you/finances/cost-of-care.html.
12. Flynn, Maggie. “Newspaper Reports Shine Harsh Light on Nursing Home Crime in Minnesota.” Skilled Nursing News, 15 Nov. 2017, https://skillednursingnews.com/2017/11/newspaper-reports-shine-harsh-light-nursing-home-crime-minnesota/.
13. Sick, Dying and Raped in America’s Nursing Homes. https://www.cnn.com/interactive/2017/02/health/nursing-home-sex-abuse-investigation/.
14. Gustafson, Craig. “Dale E. Bredesen, Md: Reversing Cognitive Decline.” Integrative Medicine: A Clinician’s Journal, vol. 14, no. 5, Oct. 2015, pp. 26–29.
15. “#30 – Thomas Seyfried, Ph.D.: Controversial Discussion—Cancer as a Mitochondrial Metabolic Disease?” Peter Attia, 26 Nov. 2018, https://peterattiamd.com/tomseyfried/.
16. Novotney, Amy. “Staffing Shortage Appears to Be Moving Upstream: Survey – Print News.” McKnight’s Long Term Care News, 7 Mar. 2019, https://www.mcknights.com/print-news/staffing-shortage-appears-to-be-moving-upstream-survey/.