Nursing homes in the United States have been devastated once again by COVID-19 during the omicron wave of the virus. Positive tests for the coronavirus among staff and residents recently reached record highs after increasing tenfold since November, according to data from the Centers for Disease Control and Prevention (CDC).
In 2022 so far, deaths at nursing homes have been climbing too, though not as quickly as before coronavirus vaccines became available — a time when those who live and work in long-term care facilities accounted for 40% of the country's COVID deaths.
On top of this, long-term care providers face a serious, pressing concern: a shrinking supply of care staff. The pandemic has only inflamed a long-standing shortage of nursing home workers that had already reached crisis levels.
With more Americans turning 65 every day, the increasing prevalence of chronic disease among them, and declining interest among students in nursing education, demand for certified nursing assistants is far outpacing supply.
The Nursing Home Workforce Is Quitting Droves
The already diminished workforce continues to dwindle as overworked staff quit in droves. This is compounded by the slow uptake of vaccines among the staff who are left behind. According to the CDC, nearly 84% of nursing staff are now fully vaccinated, compared to 87% of residents. But only 30% of staff have received boosters.
Consider this exposure of patients to COVID-19 with the shortage of care, and the situation looks dire. One ombudsman told NPR that they have seen a significant increase in complaints from facilities where there is only one certified nurse aide for as many as 50 residents.
"We are certainly seeing a huge increase in the number of calls from residents who are saying that they are not being changed, they're not receiving their meals on time," said Laurie Facciarossa Brewer, the Long-Term Care Ombudsman in New Jersey.
"So clearly, people are not going to be getting the care they need under those types of conditions where you have double-digit numbers of residents per certified nursing assistant," Brewer continued. "That's just an impossible job for that nurse aide."
Sadly, the consequences for nursing home residents could be fatal.
How Staffing Shortages Create the Conditions for Elder Abuse
According to the U.S. Bureau of Labor Statistics, the nursing home industry has lost more than 420,000 jobs since the start of the pandemic. Underpaid and overworked, some long-term care workers have been lured away by companies like Amazon for better pay and — comparably — safer working conditions. Others have opted to retire early rather than face the intensifying workload, saying it's not worth the risk of contracting the coronavirus.
As the general population grows older with increased life expectancy, it will also grow larger — a phenomenon the U.S. Census Bureau is calling the "gray tsunami." According to the U.S. Department of Health and Human Services (HHS), the population of older Americans is projected to more than double by 2040.
As the nursing home staff shortage continues to fuel burnout among workers, some facilities have been forced to shut down or limit the admission of new patients. That pressure transfers to family caregivers and hospitals, which are running out of beds as quickly as they run out of nursing homes to which they can discharge patients.
What's devastating is the overall impact on residents. The holds that nursing homes are putting on admissions leave those in need of urgent care with no guarantees they'll receive it. Those who do find a bed might face care that isn't up to standard.
This is why, as the elderly population grows, so does the prevalence of elder abuse and neglect. Healthy staff-to-resident ratios are a key indicator of care quality at nursing homes. For nursing home staff, having more patients inevitably leaves some patients unaccounted for.
Elderly loved ones may have caregivers who try their best but who unfortunately are not immune to the outcomes of poor management. At worst, nursing homes employ abusive workers or are too understaffed to notice any intentional cases of abuse.
The Common Types of Abuse in Nursing Homes
Nursing home abuse has been a prevailing public health problem in America since the 1970s, affecting 1 in 10 adults aged 60 or older in any given year.
That's because many nursing homes are run by companies or organizations that would rather focus on turning a profit than building a high-quality workforce, allowing proper vetting and training of caregivers to slip through the cracks.
In nursing homes, abuse can include:
- Emotional abuse and humiliation, such as name-calling and other degrading behavior towards elderly residents
- Physical abuse, which comes in many forms from beating to restraining
- Severe neglect, leading to health issues like untreated bedsores, malnutrition, over- or under-medication, and injuries from falls
- Sexual abuse, a widespread problem reported to authorities in only 30% of cases
- Financial exploitation, which also takes many forms, from the disappearance of possessions to identity theft
- Social isolation, which is one of the greatest risk factors for abuse and has been exacerbated by the pandemic with restricted visits from loved ones
Any of these types of nursing home abuse can lead to physical or emotional injury, permanent disability, or, in more extreme cases, death or suicide, leaving families with few options but to file wrongful death lawsuits against facilities.
Recent data from HHS shows that nursing home deaths have increased at least 32% over the course of the pandemic. Chillingly, however, these reports may only be the tip of the iceberg. The estimated 1 in 10 elders who experience abuse is a statistic many experts believe is underestimated.
As many as 4 out of 5 elder abuse cases go unreported. This lack of reporting may also be due to staff shortages: There simply aren't enough caregivers to witness and report wrongdoing.
Will This Problem Ever Go Away?
Unfortunately, the problem doesn't seem to be going anywhere. CDC data show that, though deaths are climbing again in nursing homes, they amount to only a fraction of the peak number of deaths in December 2020. The omicron variant appears to be receding. Despite these promising trends, the long-term care industry expects staffing shortages to persist.
Long-term care researchers say this is mainly due to the surge in elderly populations and a plunge in enrollment in skilled nursing courses at community colleges, whose recent graduates are avoiding nursing homes in favor of more lucrative options like travel nursing.
“This is a crisis on steroids,” said David Grabowski, who researches the economics of long-term care at Harvard University. “The long-standing issue of underinvesting and undervaluing this workforce is coming back to bite us.”
How Do We Fix Nursing Home Staffing Shortages?
The fix should be simple: higher pay and safer conditions for nursing aides. But that’s easier said than done in an industry being taken over by large corporations and investors seeking to profit off of elder care. Grabowski noted that if the government were to pay out higher Medicaid reimbursements to fund higher wages for nursing staff, they might end up lining the pockets of facility owners.
U.S. senators tried to guard against this with the Nursing Home Improvement and Accountability Act of 2021, a measure meant to improve nursing home staffing and oversight. But it was caught in congressional gridlock with the rest of President Biden's Build Back Better plan.
With the bill seemingly on pause and facility owners brazenly putting profits above safety, it's unfortunately up to families to take any wrongful treatment of their elderly loved ones into their own hands.
Know the warning signs of abuse: physical injuries, poor hygiene, malnourishment, and sudden emotional or personality changes, for example. Be ready to report them to the authorities or to your local ombudsman.
If you suspect or find out someone you love has experienced nursing home abuse, don't wait — get experienced legal help right away.