Report: Nursing homes nationwide cope with huge staff shortages

California avoids widespread shortages but still sees thousands of residents at risk

CALPIRG Education Fund

OAKLAND, Calif. — More than 3,000 U.S. nursing homes last month had a shortage of nurses, aides or doctors, the nadir for a crippling problem that started last May. At any given time throughout most of 2020, more than 200,000 Americans resided in nursing homes that admit they were suffering through staff shortages.

As the COVID-19 pandemic tore through the United States’ 15,000 nursing homes and our country as a whole last year, the number of understaffed homes increased from May to December, according to “Nursing home safety during COVID: Staff shortages,” an analysis of government data by U.S. PIRG Education Fund and Frontier Group.

In California, however, the extent of reported staffing shortages has remained low but consistent since late May, peaking at 35 homes that were understaffed. Yet seemingly small shortages can still affect many residents’ health and safety. At any given point over the past eight months, at least 1,000 Californians were potentially at risk due to staff shortages in their homes. Thus far, more than 11,000 California nursing home residents have died from COVID-19. Our report also shows that:

• In December, 31 California homes were understaffed, potentially affecting the care of 2,501 residents in those homes.

• In California, 1.9 percent of homes reported a shortage of nurses by early December, and 2.5 percent reported a shortage of aides.

• Nationwide, 23 percent of homes reported a shortage in at least one staff category: nurses, aides or clinical staff.

• Shortages of aides were the most widespread problem nationwide, affecting 20.6 percent of nursing homes in December, up from 17.4 percent in May.

• Shortages of nurses were almost as bad, affecting about 18.5 percent of homes in December, up from 15 percent in May.

• The number of homes with a shortage in at least one staff category increased to 3,136 in December, up from 2,790 in May.

“For California, this is a cautionary tale. The good news is that we aren’t seeing the widespread shortages seen across much of the country, but the bad news is that our known shortages still compromised care for thousands of residents and overburdened hard-working staff, making it easier for COVID-19 to spread,” said Claudia Deeg, CALPIRG Education Fund Associate. “The lesson is that we must continue to invest in nursing home reforms that protect staff and residents.”

Our analysis looked at data self-reported by nursing homes to the Centers for Medicare & Medicaid Services.

“We believe that the number of nursing homes experiencing staff shortages is in fact much larger than what homes have been reporting,” said Tiffany Whiten, Senior Government Relations Advocate with SEIU California. “Many nursing homes have obtained waivers for staffing requirements, and our members are reporting terrible understaffing at their workplaces which results in high levels of stress, poor working conditions and can compromise patient care.”

Our research also shows that nursing homes are still trying to overcome shortages of personal protective equipment (PPE). After these shortages improved during the fall compared to the August numbers mentioned in our first report on nursing homes, they got worse in December.

In the new report, U.S. PIRG Education Fund is calling for several policy actions to improve the situation in nursing homes. That would require approving money in a new federal COVID relief bill to buy more PPE and tests; hire more staff; and pay hazard pay, higher wages or bonuses to ensure optimal staffing levels through the end of the pandemic.

The staffing and PPE shortages are just two of the problems that U.S. PIRG Education Fund found by mining Medicare and Medicaid data on nursing homes. We will explore more of these issues in a series of reports in the months ahead.

Click HERE for our guide: “20 questions to ask your nursing home during COVID.”

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