Pennsylvania Nursing Facility Survey Reveals Magnitude of Unfilled Caregiver Positions 

The Pennsylvania Health Care Association (PHCA) released a report on the results of a membership-wide survey commissioned to gather information on the current state of long-term care. The report — the first of a two-part series — focuses on Pennsylvania’s nursing facilities, with results underscoring the significant workforce challenges providers are facing while trying to meet the public’s demand for care.The second report, set to be shared in the coming weeks, will focus on the state of assisted living communities and personal care homes.

While workforce challenges in long-term care are widely known, PHCA’s survey digs deeper to help further educate and inform legislators, regulatory agencies and members of the community about the crisis that has been developing and the impact it is already creating.

Nearly 100 percent of all nursing facility respondents said they have open direct care positions (CNA, LPN, RN), with 31 percent of respondents having 21 or more of these positions open. Subsequently, 57 percent of respondents have beds they are unable to use because they do not have enough caregivers to staff those beds. Nearly one-quarter of all respondents have between 21-40 percent of their beds available as a result of not having enough staff.

During a three month period from November 2022-January 2023, the average amount of facility denials for patients in need of care — because they didn’t have enough staff — was 17 per facility. Survey respondents also shared that their current average wait list for individuals waiting to be admitted is three people per facility. With 677 nursing facilities in Pennsylvania, this wait list average equates to more than 2,000 Pennsylvanians waiting to be admitted for care.

“It is clear our access to care crisis will not go away until our workforce crisis is first addressed. At the same time providers are facing historic workforce shortages, our aging population is rapidly increasing, with the number of Pennsylvania adults 85 and older expected to nearly double between now and 2040,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association. “While concerns and challenges remain, our survey also highlights the steps taken by providers to help meet care demands and serve their communities. But more must be done, and our elected officials and regulatory agencies can help support those efforts.”

In 2022, Pennsylvania approved a Medicaid reimbursement increase for the care of residents who are unable to cover their costs of care on their own. This increase was the first in nearly 10 years. PHCA’s survey uncovered owners of nursing facilities are planning to prioritize these funds to go toward employee wages. This type of investment can allow for providers to become more competitive with the wages they offer. Even without last year’s Medicaid increase, data from providers revealed that labor costs rose 20% between 2019-2022, and that the average Certified Nurse Aide (CNA) wage rose 12% during the same time period.

Also helping to overcome workforce challenges was the Temporary Nurse Aide (TNA) program, implemented during the COVID-19 pandemic to introduce workers to a nursing career and help them become certified while working with residents. The ability to add new TNAs through the federal program ended in June 2022. Based on information gathered through PHCA’s survey, the average number of conversions from TNA to CNA was eight per building, translating to several thousand throughout the state.

The demand for more caregivers in Pennsylvania is set to increase dramatically in 2023, as the state implements a new nursing facility staffing ratio requiring a new minimum of direct care caregivers per shift. A federal staffing regulation is also being explored and has the potential to create an unattainable and costly requirement that could force providers to discharge residents –– and could even result in the closure of facilities.