Nursing Home Staffing Crisis: COVID-19’s Lasting Effects on America’s Elderly Care

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Charday Penn - Getty Images

Since the COVID-19 pandemic, staffing shortages in America’s nursing homes have reached alarming levels, reducing the quality of care and increasing the incidence of neglect among residents. In turn, healthcare workers face intensified workloads, emotional exhaustion, and diminished capacity to meet patients’ needs. A viable solution to address this issue is to implement recruitment and retention strategies.

According to an analysis by the U.S. Bureau of Labor Statistics, 15% of the nursing home workforce was lost during the first two years of the pandemic. Poor working conditions, low pay, lack of benefits, limited opportunities for career growth, burnout, and insignificant recognition were all contributing factors. Though these issues have been around for decades, the pandemic exacerbated them and caused a staffing crisis. 

Figure 2 - The Decline of Employees in U.S. Nursing Homes

Analysis by Federal Reserve Bank of St. Louis, data from U.S. Bureau of Labor Statistics

A study conducted by Natelie E. Leland et al. for Health Services Research noted comparable factors driving staffing shortages, including fear of COVID-19, burnout, refusal to comply with vaccine mandates or PPE protocols, higher salaries in alternative employment sectors, and family obligations during quarantine. Their investigation was specifically targeted staff managing these issues.

Shortages continue today as nursing homes struggle to hire and retain quality staff.

Nursing homes are crucial to the well-being and care of the elderly, with certified nursing assistants (CNAs) serving as the backbone of the industry. They provide direct nursing care to residents while facing overwhelming workloads, emotional burnout, and insufficient resources. According to Emily Paulin, a writer for the American Association of Retired Persons (AARP), CNAs are, on top of these challenges, paid some of the lowest wages in the healthcare industry and are at high risk for work-related injuries.

With staffing shortages persisting, workers are affected by burnout, unsafe working conditions, high turnover rates, increased workloads and overtime hours, and unsafe staff-to-patient ratios, as Munday points out. Most of these factors led to the shortages in the first place but have been amplified by the ongoing lack of staff. Burnout is a significant one, as workers are compelled to assume additional duties, resulting in decreased levels of job satisfaction, greater intentions to leave, elevated turnover, and poorer health and well-being, as noted by Grunier et al.            

What impact does this have on elderly residents?

A survey report from The National Consumer Voice for Quality Long-Term Care in 2024 yields some distressing findings:

• 88% of residents stated their facilities lacked the staff necessary to meet residents’ needs.
• 72% stated excessive delays in receiving help to get out of bed in the morning, with some indicating they hadn’t been out of bed for days.
• 73% of residents miss activities due to a lack of staff.
• Nearly 40% reported not being able to eat in the dining room if desired.
• 58% indicated receiving their medications late.
• 72% reported delays for showers, some reporting showers are only given a few times a week and that staff are inadequately trained to provide them.
• 74% recounted incidents of neglect or someone getting hurt due to understaffing.

Nursing home staffing shortages have been acknowledged and addressed by multiple stakeholders, including President Biden. In April 2024, the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule took effect to mitigate the risk of residents receiving unsafe and low-quality care, as stated in Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities. This rule ensures LTC facilities give each resident 3.48 hours of direct nursing care, with 0.55 hours being that of a registered nurse (RN). It also requires an RN onsite 24 hours a day.

Nevertheless, the American Health Care Association (AHCA) still reports an accelerated shortage of staff in 2025, with a deficit of over 60,000 workers just to return to pre-pandemic levels. Just because we can provide more care doesn’t mean the quality of care improves. Shortages persist due to retirements and the younger generations not keeping pace, as facilities struggle to hire qualified and interested individuals.

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Beirut of Labor Statistics, Current Employment Statistics

So, what should be done?

First we should get more people in the door. Recruitment of staff by partnering with vocational schools or offering sign-on bonuses could be a good start. But keeping good staff is just as important.

Natelie E. Leland et al. for Health Services Research suggests the following:

• Offering higher salaries. Many workers left nursing home jobs for restaurants, grocery stores, or other healthcare settings with better pay. The time and effort staff put toward residents should be reflected in their paychecks.
• Implementing staffing standards that require a certain number of hours of care per resident.
• Going beyond general job roles and providing meaningful, patient-centered care and supportive work environments.
• Addressing staff well-being and burnout through tailored interventions, stress management programs, and development opportunities to empower staff.

Although such reforms are aimed at improving the care of facilities rather than inflate the costs, residents and prospective residents may still view this as an issue. However there is little data that connects the suggestions above to higher quoted rates for nursing homes. Those worried about the slight increases in price should understand the importance of these staffing standards and employee benefits. By requiring a specific number of nurse to resident time and improving employee morale with higher wages and benefits, not only are the staff members benefited, but the residents are more likely to receive the quality care they need.

The pandemic may be over, but the scars are still fresh. CNAs continue to bear the emotional and physical weight of a system that relies on compassion but doesn’t return it. Real change requires more than temporary solutions but long-term commitment to the people who care most about our most vulnerable. If we truly value our elders, we should first support those who care for them. Support legislation to raise CNA pay!