Caregiver putting on a mask

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Staffing shortages continue to plague senior living and other long-term care operators, with attracting community and caregiving staff remaining a “significant challenge,” along with increasing turnover, according to the latest NIC Executive Survey Insights report. 

Since September, the number of senior living (independent and assisted living) and skilled nursing operators reporting staffing shortages has been approximately 100%. Almost half of participating organizations with multiple properties (45%) reported shortages at all of their sites, up from 30% in mid-March.

Since August, more than four out of five respondents cited attracting community and caregiving staff members as their biggest challenge, with turnover increasing to 70% from 53% since mid-June. 

All respondents in Wave 35 of the survey said they were backfilling staffing shortages with overtime, and 77% reported using agency or temporary staff members. In fact, 57% of respondents indicated that their use of staffing services increased by 50% this year, whereas 20% said it increased by 100%.

Net operating income has been pressured by labor shortages and higher wages, increasing insurance costs, inflation-related materials costs, pandemic-related occupancy declines and stagnant rents.


Optimism regarding near-term occupancy recovery is lagging from recent surveys, NIC said. In September, approximately four out of five respondents expected occupancy to return to pre-pandemic levels in 2021 or 2022. That sentiment shifted in the most recent survey, with 87% expecting occupancy recovery to occur in 2022 or beyond, and 26% now not expecting recovery until 2023. 

One-quarter (24%) of responding organizations with assisted living units saw a decline in occupancy, typically associated with natural attrition and transfers to memory care and / or nursing care segments — both of which saw more occupancy growth than in the prior survey. Comparatively, 47% of facilities with nursing care beds saw improved occupancy, up from 38% in the previous survey.

On a positive note, lead volumes are improving. In Wave 35, more than one-third (36%) of organizations had lead volume at pre-pandemic levels, up from 20% in April and 33% in the previous wave.

The percentage of operators reporting accelerations in move-ins in the past 30 days did not change significantly. Between 39% and 44% of organizations reported an acceleration in the pace of move-ins, with the range varying based on care segment type. Move-in acceleration dropped to 42% in Wave 35 from 49% in Wave 34. Assisted living move-in acceleration dropped to 40% from 48%, whereas memory care ticked up slightly to 39% from 38% in the prior wave.

The recent slowdown in move-ins since June was attributed to the spread of the COVID-19 delta variant and waning pent-up demand following an unprecedented third quarter. NIC said the omicron variant could add uncertainty to the mix.

Considering the pace of move-outs in the past 30 days, the majority of organizations across all care and service segments reported no change. One-fourth of organizations (26%) with assisted living units noted an increase in the pace of move-outs, however. Independent living saw a 13% increase, whereas memory care only saw a 9% increase. 

The Wave 35 survey includes responses from owners and executives of 72 small, medium and large seniors living and skilled nursing operators received between Nov. 8 and Dec. 5.