President Biden blames nurse shortages on profiteering. I disagree.

Late last week, President Biden released proposals that rocked the assisted living sector.

In a USA op-ed he said:

Despite nursing homes receiving nearly $100 billion annually from American taxpayers, too many facilities are understaffed....We are working to make sure no nursing home can sacrifice the safety of its residents just to add some dollars to its bottom line....No more padding profits on the backs of residents and nurses.

The administration's main proposal is for an RN to be present 24/7 in all nursing homes.

I disagree with the notion that profiteering is the sole or even the primary factor contributing to the nurse staffing crisis in such facilities.

• Assisted living facilities' staffing levels are still recovering from covid. The Bureau of Labor Statistics reported a loss of more than 400,000 long-term care sector employees since the start of the pandemic. Hospitals too are struggling with staffing, and nursing homes find it hard to compete on pay and career opportunities.
• Pay increases aren't working, yet. Findings from the CliftonLarsonAllen (CLA) showed average increase in wages for nurses at all levels doubled from 2020 to 2021. Despite increases, a recent AHCA / NCAL survey of 425 nursing home providers found that 77% of operators still face worker shortages and 95% of nursing homes are experiencing difficulty hiring staff.
• Officials estimate a new safe staffing policy will cost $40.6 billion over 10 years, and that facilities will bear most of these costs. But many are currently under financial pressure. CLA predicted a median 2022 year-end operating margin of -4.8%, and that 32% to 40% of residents, or about 417,000, are currently living in nursing homes that are considered “at risk” financially. The op-ed bemoans the rise of private equity's stake in senior living. But surely increased costs will push local or regional owners to sell up, bringing more facilities into the hands of investors.

Yes, some businesses are putting profit first. But isn't this, er, normal in a for-profit healthcare system? (Forgive my ignorance, I'm from the UK).

Let's remove private enterprise from the equation. In Britain there's a fully-public system, and dire nursing shortage. Average pay in nursing homes is lower than Starbucks.

Going after private equity will play well with voters in 2024. And I'm all for putting care over money. But to address nursing homes' staffing crisis effectively, I think the administration needs to accept a 2 hard truths.

1) There is no quick win or fix that can be claimed within a 4-year presidential term. The systems needs decades of sustained investment into education and a rebrand of LTC as a rewarding career pathway for nurses.

2) Nursing needs a special category in immigration policy. In 2022, 46% of new foreign nurses in the UK were from India. Yet, Indian RNs face over a decade waiting for a US visa, due to the country's quota being filled by tech workers.

Nurse recruitment and retention is problematic for the entire healthcare sector. Let's focus on long-term, positive change in education, recruitment, and immigration, rather than singling out nursing home owners.

Follow Adam Chambers and Nurse Recruitment Experts (An Applichat Company) for more insights and analysis.

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