Understaffed, underappreciated, underrepresented: How do we support our elderly population?

Old woman in nursing home

Photo: Image designed and drawn by Tovy Udomtanasub.

Image designed and drawn by Tovy Udomtanasub. Photo courtesy of Tovy Udomtanasub.

According to the Census Bureau, 11.8%—approximately 9,600 people—of the Silver Spring population are over the age of 65. Similar to that number, over the pandemic the death rate for nursing home residents was 9200 per 100,000—106 times that of non-residents. Nursing home residents faced a death rate almost equivalent to the entire elderly population of Silver Spring during the COVID-19 crisis. These deaths revealed that the industry was, among other things, extremely understaffed, a problem that persists today. To provide the best care possible, nursing home owners need to raise worker pay.

A persistent problem

During the pandemic, many elderly needed the care nursing homes provided: 24-hour supervision, three meals a day, assistance with everyday activities, and a community. The industry remained open throughout the pandemic, but COVID-19 spread rapidly through nursing homes due to crowded living situations and a more vulnerable population. 

Not only was COVID-19 rampant throughout the industry, putting residents and workers at risk, but staff members did not have enough personal protective equipment (PPE) — masks, face shields, and gloves — to help slow the spread. Dangerous working conditions combined with low wages and the burden of caring for high-need people during a health crisis led to burnout. The industry lost 210,000 workers over two years. 

If nursing homes are understaffed, workers can suffer from extreme stress. Emily Battye, a licensed nursing assistant at the Edgewood Center in Portsmouth, N.H., found that most anxiety during the pandemic stemmed from staff shortages. Due to a lack of staff, Battye dealt with “a lot of stress... because I felt like I had a responsibility to the residents… I definitely considered if [working] was the right choice, but we were also so understaffed… I would have felt like I was abandoning the other staff,” she says. 

Staff stress can lead to a higher rate of patient abuse and neglect. Immobile patients depend on their nurses for everything from bathing and eating to taking medication. When these needs aren’t met, patients suffer from sores, infections, malnutrition, and overall poor quality of life. 

Ineffective regulations

Nursing homes are one of the most strictly regulated industries in the country, but still face issues with the quality of patient care. Ted LeNeave, CEO and founder of Accura Healthcare, a nursing home chain in Iowa, discusses how homes struggle to meet current guidelines. “Over time, the government got more involved [with nursing homes] to ensure that there are certain standards of quality at each of the facilities and so there are hundreds and thousands of specific regulations, ” he says.

Problematically, the government’s current plan to confront staffing shortages sets lofty goals while failing to provide funding to help meet them. “They're trying to say how many nurses and nursing assistants you need in every single building. And they just arbitrarily came up with a number recently and said, everyone's got to run this staffing level… 95 percent of all the nursing homes in the country already don't meet [that number],” LeNeave says. 

The staffing portion of the proposal states that nursing homes need to provide each resident with a minimum of 0.55 hours of care from a registered nurse each day, 2.45 hours of care from a nurse aide each day, and have one registered nurse on duty 24 hours a day seven days a week. While these staffing regulations might strain companies, its underlying goal of increasing and maintaining high-quality staff is sound and necessary.

But, only 2 percent of nursing homes across the country meet staffing requirements. The nursing home industry is one of the only industries that hasn’t bounced back to employment levels before the pandemic. This means the majority of our fastest-growing population is not being well cared for.  

Nursing homes in Silver Spring are facing problems too. Blair parent Mollie Manier has two family members, an aunt and an uncle, in nursing homes in the Silver Spring area, Brookdale and Riderwood. She found that while there are some truly incredible staff members at her uncle’s home, Brookdale, they are spread too thin. After Manier’s aunt returned to the nursing home from surgery at the hospital, the nurses forgot to put her on blood thinners, causing her to develop blood clots and landing her back in the hospital.

After this experience, Manier learned that it is always best to keep one foot in the game. “As a family member, it really does fall on you to double-check everything,” Manier says. A person constantly having to review the work nurses and doctors are doing to make sure their parent or relative is being taken care of can be exhausting and put a huge strain on their life. 

In another instance, a local Silver Spring nursing home closed down and gave residents very little time to move out. Blair junior Mia Brown volunteered at The Landing of Silver Spring before it closed down. While she found skilled staff and impressive facilities, she believes the industry is money-focused. “They sold [the building] for $10 million to another company. So it kind of goes to show how money-driven they are,” Brown says. 

The company also only gave residents the minimum 45-day notice to move, an experience that was stressful for residents and families. “It really sets back the memory care [residents] a lot because stability is such a big thing,” Brown says. An article by the Washington Post describes the hoops the 53 residents had to go through in order to find other housing. The Landing did try to provide some support in this process, but according to residents and their families, it was insufficient.  

Senior John Ayala, is Activities Director at Sunrise Senior Living in Chevy Chase. Ayala finds that the staff at Sunrise truly try their best to keep the residents comfortable and healthy, but they know that not all nursing homes are the same. “I always support more pay for the workers… [and] a safe community for the residents. And luckily, my workplace has that… I just wish… more nursing homes would have that benefit,” Ayala says. 

With the growing United States retired population, there will be more retired people than workers in the force by 2035. Unfortunately, current policies are inadequate to address the largest problem for nursing homes: staffing shortage. So, how can we take care of our elderly?

Raise pay. 

A Harvard study revealed that increasing pay by $1 an hour for warehouse workers increases worker retention by 2.8 percent. With customer service representatives, decreasing pay by $1 an hour led to a 28 percent increase in monthly worker turnover. Additionally, increasing pay also increases the quantity and quality of employees.“When the retailer’s advertised wages are $1/hour higher than the local outside option, they recruit 23 to 30 percent more employees in the MSA,” the study claims. 

This is similarly true in the nursing industry. In the late 1990s to the 2000s, nursing wages remained stable. When they began to increase, the number of skilled nurses in nursing home facilities grew by 284,000 in only three years. Higher wages increase recruitment, retention, and the quality of workers. 

There are many problems with current nursing homes, and they are everyone’s issues. Quality care is something everyone is entitled to, so we need to address the staffing shortage in the industry by raising pay.