Mark Parkinson and Clif Porter
AHCA/NCAL President and CEO Mark Parkinson, left, and Clif Porter, senior vice president of government relations, talk with the media Tuesday during a press conference at the organizations’ annual meeting.

NASHVILLE, TN — With the clinical issues of COVID-19 largely behind the long-term care industry, the business side “has never been worse,” according to American Health Care Association / National Center for Assisted Living President and CEO Mark Parkinson.

Speaking to the media Tuesday during the AHCA/NCAL Conference & Expo, Parkinson said that a year ago, many in the industry hoped to see a complete recovery by the end of 2022 or early 2023.

“It’s very clear that’s not the case,” he said, adding that it could take to the end of 2023 or even into 2024 before occupancy recovers.

Two challenges, he said, are preventing that recovery: occupancy and workforce.

Census remains below prepandemic levels for both assisted living and skilled nursing, with both sectors still lagging by 5%.

Workforce challenges stymie business recovery

Part of the reason for a lack of gains in occupancy is a worsening of the labor shortage, Parkinson said. Although the general workforce has recovered, assisted living is still down 40,000 workers, and the skilled nursing sector is down more 200,000 workers.

“It makes it very difficult on the care side … and it also impacts on the business side,” he said. “Providers are generally having to close wings and stop admissions because they don’t have the workers.”

With overall inflation rates north of 9% for both senior living and skilled nursing, labor costs are running 22% higher than prepandemic levels. Parkinson said he’s not so much concerned that wages are going up, indicating that the industry wants workers to make a living wage, but he said state reimbursement rates have not kept pace. 

Both Parkinson and AHCA/NCAL Senior Vice President of Government Affairs Clif Porter said they are seeing a slow but steady recovery in workforce. Porter said that many workers who migrated to staffing agencies during the pandemic now are eager to be part of a facility and a work family again.

Immigration key to building pipeline of workers

Another focus on restoring workforce numbers is  immigration, the executives said.

Clif Porter said he’s not optimistic that any significant movement will occur on immigration in the near term. AHCA/NCAL is using the congressional lull prior to the midterm elections as an opportunity to amplify its message and articulate the challenges communities are facing at the local level, he said.

Nate Schema, president and CEO of the Evangelical Lutheran Good Samaritan Society, told McKnight’s on Tuesday that his organization views immigration as a key way to build a pipeline of long-term care workers, especially for rural locations. But of 250 immigrant recruits committed to work for the provider, only three have arrived since early 2021, he said.

“We need to expand those floodgates around immigration. I know it’s a hot-button issue on both sides of the aisle, and for a variety of reasons, we’ve struggled to get anything across the finish line,” he said. 

Schema had just come from a session for not-for-profit operators during which economist Ron Hetrick discussed the demographic shift in the United States and a worker shortage predicted to worsen due to a general decline in childbirth and the 2020 “baby bust” in particular. 

“It’s pretty sobering today when you see we have nearly 10 million job openings and many of these are for unskilled labor positions in hospitality and certainly healthcare,” Schema said. “For us to even get to a sustainable level, we need an additional 3 to 5 million folks to be coming to our country every single year.”

The amount slowed to a trickle during the pandemic, and the government, itself short-staffed, continues to work through a backlog of applications.

“From a policy standpoint, No. 1: We need more people,” Schema said. The demographics clearly show we’re not having enough kids in the United States. The numbers don’t work out, so something’s got to change to continue to draw people to this industry.”

Little concern over increased federal oversight

And despite the fact that senior living tapped into federal COVID-19 relief funds to cover some pandemic-related costs, both Parkinson and Porter said they are watchful, but doubtful, that the sector will see increased federal oversight any time soon.

Porter said there has been much discussion about increasing federal regulation of assisted living, but as long as the industry primarily is funded by residents’ private funds, that will remain unlikely.

“Regulation remains robust, but at the state level,” he said. 

Increasing Medicaid access through HCBS

AHCA/NCAL has become more involved in state Medicaid efforts over the past five to seven years, Parkinson said, adding that more advocacy can be done at the state level than at the federal level.

The CEO said that the ability of assisted living providers to participate in the Medicaid program through state home- and community-based services waivers “opened the product to a swath of the population that has not had enough money to qualify.”

“Innovative operators have figured out how to make it work in the HCBS setting,” Parkinson said, adding that AHCA/NCAL is supporting that work by working with the Centers for Medicare & Medicaid Services on what an HCBS waiver should look like.

The conference ends Wednesday.

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