Audit Shows PA Nursing Homes Understaffed, Problem Projected To Get Worse

Jul 24, 2019

An audit of Pennsylvania nursing homes warns that staffing levels at these facilities are insufficient and on track to get worse.

“We are facing an eldercare crisis, and we continue to ignore it at our own peril,” said Pennsylvania Auditor General Eugene DePasquale.

One of the main reasons for the worker shortage is the intense physical and emotional demands of these jobs, paired with relatively low pay.

"Nursing home direct care workers are currently, and have been historically, underpaid. And that is part, I think, of the reason why people choose to work in other environments and other places," said Ellen Flaherty, past president of the American Geriatrics Society, and director of Dartmouth Centers for Health and Aging in Hanover, New Hampshire. 

The Bureau of Labor Statistics reports that in 2018, the median income for nursing assistants or aides was $28,540 a year, or $13.72 an hour.

“Without family-sustaining wages and benefits, the eldercare workforce will never grow to the size we need to care for aging Pennsylvanians,” said DePasquale. “The number of health care workers is clearly not keeping pace with current demand, and is currently not keeping pace with future demand, which is going to explode rapidly.”

A 2014 study from the Center for Rural Pennsylvania estimated that by 2040, nearly a quarter of the state’s population will be 65 years or older. This is, “due largely to the aging of the baby boomers and Pennsylvania’s consistently low fertility rate," said the report.

DePasquale suggested that raising the state minimum wage and increasing Medicaid reimbursements would lead to higher salaries for nursing home workers, thereby attracting more people into the profession.

The Pennsylvania Health Care Association, which represents both for-profit and nonprofit nursing homes, did not comment on the audit's assessment of worker wages. But the organization agreed that Medicaid reimbursements would help attract more direct care workers.

"The Pennsylvania Health Care Association (PHCA) has continually fought for higher Medicaid reimbursement, a more favorable legal and regulatory environment, and workforce training programs," said PHCA executive director Zach Shamberg in a statement. "Without each of these key components, the next few years will only result in more and more long-term care providers selling their facilities, changing ownership or closing their doors altogether."

But some argue that even if wages and Medicaid reimbursements were increased, nursing homes would still be short-handed. 

“It’s a deliberate decision by many of the owners to not hire adequate staffing," said Charlene Harrington, a professor emeritus of the University of California San Francisco’s School of Nursing, where she specializes in nursing homes, staffing and scheduling. 

Harrington said for-profit nursing homes are able to make "excessive profits" by employing minimal personnel.

"The workers can’t get the work done because staffers don’t have enough staff to do it. Patients are neglected and abused," she said. “Ulcers … falls … weight loss … overuse of anti-psychotic drugs … all the problems found in nursing homes are related to inadequate staffing.”

The Centers for Medicare and Medicaid Services recommends that, at minimum, nursing home residents receive 4.1 hours of direct care. Current state regulations mandate that residents receive only 2.7 direct-care, though the Pennsylvania Department of Health is reviewing whether to update this policy.