HELP DESPERATELY WANTED — Health care is recovering unevenly from the pandemic. Eldercare and care for the disabled are among the hardest hit. How bad is it? The number of nursing home employees dropped from 1.5 million in February 2020 to 1.3 million in December 2022 — a level not seen since 1994. And it’s not just nursing homes that are precariously short-staffed. Community adult day programs. Home care. Assisted living. Even hospice. Care for our most fragile and vulnerable — an essential social good — is in the midst of a years-long crisis. That has ripple effects throughout health care. When LeadingAge, the trade association for nonprofit aging providers, did a snap poll of its members recently, they all reported that worker shortages are just as challenging now as they were a year ago, when the pandemic was far worse. They don’t have enough workers. And they don’t retain workers; turnover is very, very high. Ruth Katz, the organization’s vice president for policy, told Nightly that the only long-term care provider she’s come across recently that doesn’t have a staffing crisis was a nursing home run entirely by Mennonite volunteers. Some nursing homes aren’t even filling all their beds, because they don’t have enough people to provide care. “They aren’t even keeping waiting lists,” Katz said. Elder care is hard. It requires patience. It requires attention to detail. It is physically difficult and includes lots of lifting and moving. Those who take care of the elderly are not well-paid. One woman I spoke to recently in Texas said the aide who helps her mom, a stroke victim with dementia, makes “about what I made per hour part-time in high school.” Much of the burden falls on families — some 53 million Americans are family caregivers. Many give up paid jobs, or downshift to part-time. The squeeze from the professional workforce shortage only makes the family tasks bigger. Right now, several factors are making the care workforce shortage even more acute. In the overall U.S. economy, there are around 1.7 jobs open for every one person looking, meaning people who might have worked as caregivers now have other options, with better pay. To attract or retain workers, a retail chain or a fast food joint can add a few pennies to the price of Band-Aids or burgers. In fact, that’s exactly what they are doing, one contributor to the inflation we’re experiencing. But much of elder care — whether long-term care or shorter-term rehab and recovery — is paid by Medicaid and Medicare, and the government sets the rates. Congress is utterly disinterested in spending more on health at the moment. Another potential solution is giving special visas to more nurses or other caregivers to enter the country. A recent study for the National Bureau of Economic Research, co-authored by Harvard’s David Grabowski, one of the top experts on nursing homes, found that immigration has “a very positive effect” in nursing homes. Patients get more care, and they get better care. Katz also noted that many elder care workers are already foreign born. But pretty much anything to do with immigration is a nonstarter on Capitol Hill. Soon, the problem might get more complicated. The Center for Medicare and Medicaid Services, which has stepped up oversight after Covid infections tore through nursing homes, plans to release nursing home staffing requirements this spring — which some in the industry say will just make matters worse. In the process, CMS has heard from relatives of people in nursing homes who “voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities.” Families reported that their loved ones go entire shifts without even the most basic assistance, like help getting to the bathroom. That leads to falls, when fragile people try to get up themselves, or to hard-to-heal pressure ulcers — aka bed sores — if they are left lying in one position for too long. For Katz, the workforce crisis is the flashing red light signaling that we just aren’t facing up to the demographics of an aging America. That requires a culture shift, she said, respecting the hard work caregiving entails as well as better understanding our elders. “Whether you are working in a department store or Disneyland,” she said, “you are going to need to know how to deal with older people.” Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight’s author on Twitter at @JoanneKenen.
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