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Workforce Plight Persists, LeadingAge Poll Reveals

Staffing Challenges Not Easing; Nursing Homes, Assisted Living Shortages “Severe”

Aging services’ long-standing workforce challenges, exacerbated by Covid-19, persist, even as America emerges from the pandemic. Nonprofit, mission-driven aging services providers, who care for older adults and families in a range of settings and communities, report continued difficulties recruiting and retaining staff; deepening financial strains due to reliance on expensive staffing agencies; and frustration with federal policymakers’ inaction on legislative approaches that would address this increasingly dire situation.

The results of an informal, “snap” member poll, conducted from February 21 to March 13, 2023 by LeadingAge, the association of nonprofit, mission-driven providers of aging services, demonstrate providers’ ongoing struggles. “The hours are insane … it is getting really scary in long-term care,” said one LeadingAge member. “I’ve been doing this for 32+ years and this is the most dire time I have ever seen.” In fact, 64% of respondents say that their workforce situation has not improved since June 2022, when the association last queried members to gain deeper insights into the severity of the issue.

Workforce is a top advocacy priority for LeadingAge and its 38 state partners, because without staff, there is no care. Providers’ plight ultimately impacts older adults’ and families’ ability to access much-needed care and support.

“A robust high-quality, person-centered care system is essential to serve all of us as we age,” notes Ruth Katz, senior vice president, LeadingAge, in a March blog reporting on poll findings. She adds that “we will continue to raise our united voices to ensure policymakers are part of a solution to this problem. While some leaders in Congress, including members of the Senate HELP committee, demonstrate a grasp of the current staffing crisis in long term care, more attention -- and action -- is critical. Long-term care is a key component of our country's health care system; without sufficient staff to deliver the services our nonprofit members provide, older adults and families simply cannot get the care they need."


Of the 891 respondents in this current polling, 140 (16%) offer adult day services; 208 (23%) offer affordable senior housing; 501 (56%) offer assisted living; 192 (22%) offer home health; 160 (18%) offer hospice; 255 (29%) offer life plan communities; 633 (71%) offer nursing home care; 30 (3%) offer Program of All Inclusive Care for the Elderly (PACE), and 139 (16%) offer other services (independent living, memory care, etc.). The key findings are below.

Severe staffing shortages still exist in multiple aging services settings, with particular difficulty recruiting and retaining staff—especially nursing roles.

  • Respondents report the top three most difficult positions to recruit: registered nurses (86%), licensed practical nurses (85%), and certified nursing assistants (85%), the same as in June 2022.

  • 92% of nursing home respondents and nearly 70% of assisted living respondents still report significant or severe workforce shortage, as they did in June 2022.

  • Respondents report staff are still leaving positions for better pay (78%), better work schedules (53%), and due to burnout/professional fatigue (73%), just as in June 2022

We have closed wings/neighborhoods due to staffing to avoid agency usage - both personal care and SNF. Also in Home-Care, we have limited the number of clients we can serve due to insufficient staffing to meet the needs.

Agency staffing is becoming more popular, but it is really detrimental to resident care. We pay much more for agency staff than is affordable and the quality of work from agency staff is much worse than our own - reduced consistency of care/knowing our residents wants/needs.

Our agency numbers have more than doubled. We are having more people leave due to retirements and not seeing applications coming in to replace them, even after significantly increasing our pay scales.

Members continue to work on creative and sometimes drastic solutions for recruitment and retention of aging services professionals.

  • Of the 70% of respondents that reported implementing tactics to attract direct care professionals, 69% offered sign-on bonuses, 92% offered increased hourly wages, and more than half offered creative scheduling (61%) and career advancement opportunities (56%).

We made an investment and change to the organizational structure to create a Workforce Department to solely focus on the workforce demands faced post-pandemic. A team of (5) professionals is focused 100% of their time on improving operational performance related to workforce, including key areas such as talent acquisition, scheduling and internal float pool (creating an agency).

Members report minimal success, but strong interest building in the pipeline of potential workers by tapping into immigrant and refugee talent pools.

  • 12% of responding organizations have successfully recruited foreign workers from the Philippines, Puerto Rico, Canada, and other countries to work in the United States through work-based visas, and 5% have hired workers on refugee status.

  • Interest in foreign recruitment is high among respondents with nearly 200 comments in the poll, and they are interested in better policy solutions to ease that path.

We are in the process of starting a foreign workers program but our approval for prevailing wages has been pending for 6+ months. There seems to be no urgency among the government agencies involved in this process.


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