Public Release: 

Long-term care staff crisis costs lives yet could be solved

Cornell University

ITHACA, N.Y. -- Nursing homes and other long-term care facilities are facing the worst staffing crisis ever, resulting in patient deaths, injuries, careless errors and risk of abuse, says Cornell University gerontologist Karl Pillemer. These problems are leading to forced shutdowns of some nursing homes, he says.

"This situation is especially tragic, however, because -- unlike many persistent human problems -- we know both the cause and the cure of the nursing home crisis," says Pillemer. He is a professor of human development, co-director of the Cornell Gerontology Research Institute and a leading expert on long-term care and staffing issues in long-term care facilities.

Pillemer recently addressed a national conference at the University of Maryland Law School on "The Crisis in Long-Term Care," attended by officials from the U.S. Department of Justice, state attorneys offices, law enforcement agencies and lawyers who represent both plaintiffs and the nursing home industry.

Pillemer says the staffing crisis is of unprecedented proportions, with many facilities experiencing a 100 percent rate of staff turnover. Yet, he says, the crisis could be relieved by offering higher pay to nursing assistants, many of whom are paid at or near poverty levels, by upgrading the training and professional development of these workers and by establishing a national commission to deal with these issues.

"What's at stake here are the lives and welfare of the entire baby boom generation and their parents," says Pillemer, pointing out that numerous studies show that resident relationships with staff is the most important component of quality care, more important than improvements in environment, food or activities. "The crisis has been triggered by a shrinking labor pool and competition from other industries. Restricted government funding and seismic changes in health care exacerbate the problem," Pillemer says. "Many workers in the industry are stressed and demoralized, and keeping the facilities fully staffed is a nightmare for administrators all over the country." Meanwhile, he says, the elderly population is growing "explosively," and the long-term care population is becoming more disabled and complex to care for. However, that portion of the population that makes up the long-term care work force -- individuals (and primarily women) between the ages of 25 and 50 -- will grow only marginally over the next few decades. Adding to the problem are restrictive immigration policies that reduce the labor pool.

"Of course, the worker shortage affects many industries. But in, say, the hospitality industry, the worker shortage means that you may wait longer in line to get your room. In nursing homes, short staffing can be literally a matter of life and death. Study after study shows that higher numbers of staff and low staff turnover lead to better care for residents, less illness and reduced mortality," Pillemer says. "We simply can't assume that we'll have an endless supply of caring, competent people who are willing to bathe, feed and watch over our loved ones while receiving low pay and few or no benefits."

A congressional investigation has found widespread violations of federal health and safety standards at nursing homes in numerous states, and federal and state officials have begun imposing fines on hundreds of nursing homes for substandard care. Pillemer notes: "It's very rare that a complex problem has a relatively simple solution: Upgrade the quality and training of front-line workers in long-term care."

Pillemer calls for creative partnerships of government, business, labor organizations, advocacy groups and educational institutions to address this complex problem. "Solving the nursing home staffing crisis is not merely altruistic. The aging of the baby boom generation will create tremendous demands for elder care. Many of us will reside in a nursing home before we die. We must act now to build a caring, competent nursing home work force, or we will all suffer the consequences," Pillemer says. "If we fail to act soon, care is going to get dramatically worse."


In an effort to upgrade the nursing-assistant profession, Pillemer has published several manuals for both nursing assistants and their managers. These include The Nursing Assistant's Survival Guide (1999) to help nursing assistants in long-term care facilities cope better on the job;Leading the Way: Practical Management Skills for the Long-Term Care Nurse (1997), to help nursing home supervisors develop management skills; andSolving the Frontline Crisis in Long-Term Care: A Practical Guide to Finding and Keeping Quality Nursing Assistants (1996), for nursing home administrators. He is also the executive editor of a newsletter, "Nursing Assistant Monthly," which promotes nursing assistant professional development.

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