Iowa needs to tackle the workforce crisis in long-term care settings

A nursing home employee assists a resident. (Photo by Getty Images)

It’s no secret that older Iowans in nursing homes have been hit disproportionately hard by COVID-19.

As of Dec. 15, 141 Iowa nursing homes were reporting COVID outbreaks. The number of COVID related deaths in Iowa nursing homes was 1,132, representing about a third of all deaths in the state. They were residents and staff members. They were someone’s spouse or partner, parent, brother, sister, aunt, uncle, good friend, or neighbor. Each loss was grieved, and made even harder when loved ones were not with them at the time of death.

In recent press conferences, Gov. Kim Reynolds has discussed the COVID crisis in Iowa’s nursing homes, and the workforce shortages that exist there. Many questions have been raised as a result. Here are some of them, and our comments.

Q. Much of the concern about the growth of COVID relates to the workforce available to care for nursing home residents. Are staffing levels adequate?

A. Nursing home industry spokespeople say staffing levels have been and are adequate. We strongly disagree.

The limited data available from state government indicates that thousands of vacancies existed in Iowa nursing homes prior to the pandemic, and that thousands of annual vacancies are projected well in to the future. These observations are reinforced by what residents, family members, current and former nursing home staff, and advocacy organizations say – that staffing levels were inadequate before the pandemic, and are worse now.

Many of the vacancies are attributed to the high levels of annual turnover among certified nurse aides that runs over 60% annually, according to state data. The vacancies are difficult to fill because the jobs pay a less-than-livable wage, offer few benefits, provide inadequate training and no career path to reward excellent performance and attitudes.

COVID has deepened the workforce crisis, as more frontline workers have left the profession due to illness, fear of illness, concerns about child care or other family challenges, or the ability to find a better and safer work environment in some other occupation.

 Q. The governor’s guidance on workforce shortages indicates there are “extra” staff members who could be loaned to struggling facilities. Is this true?

A. There is no pool of extra workers. Hospitals, nursing homes, assisted living centers and home care agencies are all short of staff, as indicated by existing employees working extra shifts, employees expressing concern about not having the time and/or not having enough co-workers to do their jobs well, and media reports calling these front line workers “overwhelmed and exhausted.”

Governors and legislators have known about the workforce crisis in long-term care settings for years but have done little more than talk about it. The chickens have now come home to roost. Their inaction has produced disastrous consequences.

We’ve been told by legislators and appointed officials in government that the workforce crisis in long-term care settings in the state just isn’t “sexy,” that the jobs don’t pay enough to warrant any priority, that those who do this work are “low-skilled” and that “people aren’t dying” by the lack of attention to this ongoing workforce challenge.

Well, now people are dying. The time for excuses and convenient rationalizations for inaction has passed.

Iowa needs to deal with this crisis in the upcoming legislative session. Our elected and appointed leaders should remember that they have described these frontline staff members as “heroes.” It’s well past time to have these nice words backed up with meaningful action.

Q. What are the main takeaways?

A. Sadly, the number of outbreaks and deaths and the amount of suffering in long-term care settings document how inadequate the response has been in recognizing and dealing with both the COVID and workforce crises.

Here’s the bottom line: COVID has put a spotlight on workforce challenges that have existed for decades and will continue to exist once COVID is no longer a concern. It’s time to use this bright light to move from talk to action – to build a workforce in nursing homes and other long-term care settings that will be big enough, stable enough and of the quality needed to ensure that all Iowans are provided the kind of care wanted and deserved.

To do so, the governor should highlight the crisis in her Condition of the State address in January and request legislative action. The actions should be built around two simple ideas:

  •  START to meet more with, listen more to, and to address the recommendations of consumer, worker and caregiver advocates at the Statehouse. These non-industry representatives will propose a 2021 agenda that would greatly improve the jobs and lives of those working in long-term care settings, and improve the quality of care to those they serve.
  •  STOP giving additional taxpayer dollars to nursing homes and other long-term care providers with no expectations on how the funds are used, or the results they produce.

What’s been done in the past hasn’t worked. More money has been provided, yet the workforce crisis has grown.

It’s time for new, clear messages from legislators to nursing homes and other providers of long-term care services:

  • Additional dollars must be used to grow and sustain the workforce – to improve pay and benefits, enhance training, expand career growth opportunities, and ensure a safer work environment.
  • Reporting requirements must be put in place so that both legislators and the public will be able to easily see where the money has gone and what results have been produced.

2021 should be the year that the long-term care workforce crisis is finally recognized and dealt with. We’re asking the governor and legislators to make that happen.