The ongoing issue of understaffing in the healthcare industry affects senior care centers—such as nursing homes—where understaffing affects the physical and mental health of elderly residents.
According to National Institute on Agingnursing homes, or skilled nursing facilities, focus on medical care for the elderly, providing “care, 24-hour supervision, three meals a day, and assistance with daily activities.”
Assisted living facilities, another type of long-term care facility, provide similar services but focus more on day care and less on medical care.
According to the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL), research in 2021 found that 94% of nursing homes face staff shortages. The shortage is partly caused by a chronic lack of funds Medicaid for nursing homes, which “only cover 70% to 80% of care costs.”
The pandemic also had a significant impact on the nursing shortage—according to National Council of State Boards of Nursing100,000 nurses have left the workforce during the pandemic, and nearly one-fifth of the 4.5 million registered nurses, or 900,000, plan to leave by 2027.
“Nurses are the backbone of the healthcare system and are needed in all care settings, including nursing homes, to provide a wide range of healthcare services,” said Robert Rosseter, chief communications officer at American Association of Colleges of Nursing.
According to Rosseter, due to an aging population, nursing retirements and increasing opportunities for nurses, the demand for a nursing workforce continues to grow, creating imbalance in supply and demand.
“Nurses are the health care providers who spend the most time with patients and play a critical role in patient education and recovery. Since the pandemic, we have seen increasing reports of nurse dissatisfaction due to burnout, understaffing and poor working conditions,” said Rosseter.
Salary is another factor in staff shortages, especially in aged care facilities.
“After the COVID-19 pandemic, because there were so many traumatic experiences in nursing homes, healthcare workers were not interested in returning. They’re also very poorly paid—there are plenty of better-paying jobs elsewhere,” said Emiko Takagi, an associate professor of gerontology—the interdisciplinary study of aging and the elderly—at San Francisco State University (SFSU).
As senior care centers struggle with staff shortages, residents are feeling the effects of a lack of care options.
“If the facility is understaffed, you get less attention. If you ask for help, you may have to wait 20 to 30 minutes just to go to the bathroom. The lack of staff means that basic physical care is falling, which could definitely affect the mental health of the elderly,” Takagi said.
If the facility is understaffed, you get less attention. Lack of staff means a reduction in basic physical care, which could definitely affect the mental health of the elderly.
— Emiko Takagi
Furthermore, according to Takagi, elderly people may feel neglected if they feel they are receiving insufficient care.
“If older people aren’t making connections or interacting with staff, they often have less time to talk to people. It’s a vicious cycle if you don’t have good human resources in the facility,” Takagi said.
There is also a link between physical health and mental health that is more severe for older people compared to younger people.
“If you’re depressed, weak, and less physically active, mental health issues can really worsen underlying conditions you already have,” Takagi said.
However, while certain diseases, especially associated with memorycan significantly affect the health of the elderly, nursing facilities usually provide activities to exercise the mind and combat these diseases.
“The brain is something we have to keep active. For people with conditions like dementia and Alzheimer’s disease, any kind of stimulation that comes from doing puzzles, listening to music or art therapy is important,” said Takagi.
However, at the same time, the cost of the service is another barrier between the elderly and the basic care provided by nursing homes, as such facilities are usually expensive.
“Even if you need it, it’s not necessarily something you can access,” Takagi said.
Other, more hidden barriers have a more significant impact on the treatment of the elderly.
“If you think about how people make fun of older adults, that attitude can be reflected in how staff treat residents in care facilities, which can have a negative impact on healthy residents. For older people who want to work, stereotypes surrounding aging make employment difficult. “Ageism is not as visible as racism or sexism, but it is a big topic in gerontology,” Takagi said.
With underpaid staff and a consequent lack of sufficient workers, some residents feel that the quality of care is declining dramatically.
“At one point, two people were working with about 17 or 18 residents. You couldn’t find anyone to get you in or out, or anyone to help you or your family member,” said Ashlee Bentley, whose mother previously lived in oakmont, assisted living center in Redwood City.
According to Bentley, her daughter was making more at her regular job than the salary at Oakmont, which she believes contributes to the facility’s inability to attract skilled workers.
“The biggest problem that the elderly face today is they find safe, quality, loving care when they need it most. There are many people who are completely unqualified to care for the elderly who are at high risk of harm ranging from physical harm, neglect and financial harm,” said Bentley.
Marjorie Casison previously worked at Center for skilled care and subacute patientsnursing home in Santa Clara, as a preventative of infections.
Casison’s patient-to-staff ratio at her previous job did not seem adequate to provide comfortable and safe care. Furthermore, the isolation required for infection control often leads to many health consequences for patients.
“When implementing an infection control program, certain diagnostics required patient quarantine to prevent the spread of infection, in which patient interactions within the facility were limited to basic needs only. Social activities, dining and visits would only be allowed if certain criteria were met on a case-by-case basis,” Casison said.
According to Casison, despite the facility’s staff’s efforts to ensure activity and interaction in the room, signs and symptoms of depression continued to manifest—she noticed crying, decreased appetite resulting in weight loss, and excessive sleeping, among other indications.
One of her biggest concerns in nursing homes is the lack of experience and proper training among leadership and management. Casison suggests extensive training programs for staff to ensure they are qualified to care for patients.
“Year an inexperienced leader leading a team is like a blind person leading another blind person. It causes more harm than good,” Casison said.
According to Casison, the ability to connect with patients is a fundamental requirement for leadership.
“If the leaders have no experience, even if they are smart enough, some things cannot be cut off. If you’ve been in their shoes, you know how they feel because you can empathize. When they have difficulties, you can help them, and this is an advantage because health is not only physical health. There’s also mental health,” Casison said.
During her time in the nursing home, every day was different – sometimes there would be touching moments, but sometimes there would be conflict.
“Health is unpredictable. You just need to come and be ready to work. It’s not like an office job where you do this, check this or submit this. Every day someone could have a problem that wasn’t there yesterday,” Casison said.
Meanwhile, as age continues to cause problems for older people and the general perception of older people, it is important to recognize that aging is a process that occurs universally, regardless of identity.
“Stereotypes arise when there is a lack of communication between generations. Try to talk to older people in your community more and don’t be shy. Make friends, Takagi said.