Nursing Homes Lost More Than 380K Jobs During Pandemic, U.S. Data Shows

Nursing homes lost more than 380,000 jobs in the past year and a half over the course of the COVID-19 pandemic, according to Bureau of Labor data.

Nursing home employment had grown steadily in the decade prior to the pandemic, but low wages, risk of COVID-19 infection and the economic impact of the pandemic caused many workers to either quit or be laid off.

According to the American Health Care Association, which lobbies for care facilities, 99 percent of nursing homes and 96 percent of assisted living facilities said they had staffing shortages in a September survey. In a June survey, the organization found 84 percent of nursing homes were losing revenue due to fewer patients coming from hospitals.

"The labor shortage in long-term care is the worst it has been in decades. Many facilities are now in danger of closing because of workforce challenges," the AHCA said. "If we want to improve the workforce situation in nursing homes, we need policymakers to make a long-term investment."

For more reporting from the Associated Press, see below:

Nursing Home Deaths
Nursing homes lost over 380,000 jobs over the course of the last year and a half during the COVID-19 pandemic, with staff shortages contributing to poorer conditions for patients. Family members of seniors who died in nursing homes of COVID-19 hold a rally and demand Governor Cuomo's resignation or impeachment, March 25 in Foley Square, New York City. Andrew Lichtenstein/Corbis via Getty Images

When Natalie Walters arrived at her father's nursing home, the parking lot was nearly empty and, inside, the elevator made no stops. On the 13th floor, the lights were off and the TVs silent. The last time she was allowed inside, nine months earlier, aides passed in the hall and a nurse waved from the records room.

Now, it felt like a ghost town.

One of the few staffers on duty broke the news: Walters was too late and her father was already dead of COVID-19. In the nursing home's newfound emptiness, the scream she unleashed echoed in the void.

"It was so still and quiet," said Walters, whose description of desolation at the home aligns with records showing its staffing level has fallen over the course of the pandemic. "How alone must he have been."

Even before COVID-19 bared the truth of a profit-driven industry with too few caring for society's most vulnerable, thin staffing was a hallmark of nursing homes around the country. Now, staffing is even thinner, with about one-third of U.S. nursing homes reporting lower levels of nurses and aides than before the pandemic began ravaging their facilities, an Associated Press analysis of federal data found.

"It's already so low. To drop further is appalling," said Charlene Harrington, a professor at the University of California, San Francisco, whose research on nursing homes has frequently focused on staffing.

As COVID-19 engulfed homes, some workers fled over fears of exposure. Others were lured to easier work at similar or higher pay in restaurants and stores. And some were laid off by homes as occupancy fell.

Nursing aides are the backbone of homes' staffing. They are overwhelmingly female and disproportionately members of minority groups and, working jobs with high injury rates and low pay, the industry has long struggled to hire and retain them. Critics said if they simply boosted wages, the applicants would come.

Whatever the reason for skeletal staffs, the result is clear: Residents have fewer to answer their calls to keep them safe, clean and fed, while facilities have helped their bottom lines.

Some 32 percent of nursing homes reported staff-to-resident ratios in June that were lower than those in February 2020, AP's analysis showed. In homes posting lower ratios, the average resident had 21 fewer minutes of contact with staff each day, or about 11 hours a month, translating to scarcer help at mealtime, fewer showers and less repositioning to prevent painful bedsores. In the worst cases, when someone falls, chokes or is otherwise endangered, it means there are fewer people to discover the problem or hear their calls for help.

Tamika Dalton saw it first-hand with her 74-year-old mother, who moved to Blumenthal Nursing and Rehabilitation Center in Greensboro, North Carolina, in January 2019 as her multiple sclerosis worsened. At the time, the facility had a staffing level above the benchmark recommended by many experts.

But once COVID-19 kept visitors from going inside, Dalton peered through her mother's window, seeing fewer and fewer aides pass by and her mother sometimes sitting for hours in a soiled diaper. Her hair was often matted and her toenails grew long. A bedsore the size of a fist festered on her backside. Sometimes, unable to dial a phone herself and with no aides in sight, she would holler to a passing custodian for help.

"She would call out for help and no one would come," she said. "There was no one around."

As conditions continued to deteriorate, Theresa Dalton, a retired minister, contracted COVID-19 and died February 12. By June, the facility's staffing was down 15 percent from the start of 2020, and 25 percent from the start of 2019.

"They did that for their own pockets," Tamika Dalton said of the lower staffing. "There's a lot of greed."

Requests for comment to Blumenthal and its operator, Choice Health Management Services, were not returned. In a letter to state regulators, an attorney for the facility said complaints were taken seriously and that some problems, like the bedsore, were exacerbated by the patient's failure to follow orders.

"The facility never fell below staffing expectations," the letter said.

Many families of those who have died in nursing homes since COVID-19's start are convinced their loved ones' deaths were precipitated or hastened by poor staffing. Linking an individual death to staffing is difficult, but studies have repeatedly linked higher nursing home staffing with better outcomes.

Harrington has little doubt that low staffing, combined with poor testing practices and lack of protective equipment, played a role in COVID-19's proliferation.

"This is why the infections spread," she said. "If the nursing homes had beefed up their staffing, done the testing twice a week and had adequate PPE...they would have saved thousands of lives."

Natalie Walters
Natalie Walters' father, who was staying at the Loretto Health and Rehabilitation nursing home in Syracuse, New York, died of COVID-19 in December 2020, and Walters wonders if poor staffing played a role in her father's infection or death. Walters, 53, holds a photo of her parents, Jack and Joey Walters, near her home in Syracuse, New York on September 21. Heather Ainsworth/AP Photo