A long-predicted shortage across the continuum of nursing and direct care workers has come home to roost in the coronavirus pandemic. Shortages are rippling across the country, fueled in part, experts say, by pandemic trauma and burnout.
The issue is critical in Western Pennsylvania.
In a region characterized by a rapidly graying population and a shrinking workforce, “Help Wanted” signs are popping up at private home care agencies, personal care homes, assisted living and nursing homes, community hospitals and sprawling academic and tertiary care hospitals.
Like the fast food industry, some hospitals desperate to fill nursing vacancies are dangling signing bonuses — as much as $15,000 for experienced registered nurses at UPMC and AHN hospitals and outpatient facilities.
At the most basic level, staffing agencies that provide nonlicensed short-term care workers who help people remain in their homes and avoid moving to a personal care or assisted living are simply turning away calls for help.
“We are turning away new clients by the drove. We cannot handle anywhere near the care we’d like to provide because we cannot hire enough people,” said Krista Braha, human resources manager for Carol Trent Senior Helpers in Greensburg.
Although Senior Helpers offers bonuses to employees who refer new workers, Braha said they can’t keep up with demand. Offering wages of $11 to $12.50 an hour with no health insurance, they are competing with gas stations, restaurants and retail stores clamoring for workers.
One level up, at personal care homes and assisted living facilities that house nearly 45,000 people across the state, some facilities are paying as much as $50 an hour to fill pressing vacancies for nonlicensed caregivers, said Margie Zelenak, executive director of the Pennsylvania Assisted Living Association.
At least two personal care homes told her they decided to close in recent weeks, citing an aging owner and an inability to hire help.
Zelenak said her group hopes the situation will improve this fall when schools reopen. That could allow some who left the field to care for children doing remote learning at home to return to work.
But that won’t resolve long-term shortages that have long been forecast.
“It is a problem, and it is going to increase as our senior population continues to increase, “ Zelenak said.
The shrinking workforce is starkly apparent in monthly labor force reports.
A report from the U.S. Bureau of Labor Statistics counted employment in nursing homes and residential facilities across the six-county region down by 1,100 workers since May 2020.
Experts say the pandemic exacerbated a difficult situation that existed before covid-19 began taking its toll.
Skilled Nursing, a journal that follows the nursing home industry, cited a recent analysis of federal data from 15,000 nursing homes across the country that found an average turnover rate of 140% among registered nurses (RNs), 114.1% among licensed practical nurses (LPNs) and 129.1% among certified nursing assistants (CNAs).
Officials are adapting to the new normal at Redstone Highlands, which serves 1,000 elderly and disabled residents through home care, personal care and skilled care facilities in Greensburg, North Huntingdon and Murrysville.
“We are having a horrible time hiring to fill positions,” President and CEO John Dickson said.
Redstone created rapid-response positions within its staffing office — jobs that do not include benefits but which pay more and require staffers to work weekends and evenings. Even before the pandemic, Redstone worked through the Healthcare Council of Western Pennsylvania to bring in three registered nurses from the Philippines.
A spokeswoman for Excela, which operates three hospitals and multiple outpatient facilities across Westmoreland County, said recruitment and retention are at the top of the list across all positions. Excela, which provides clinical training rotations to several college nursing programs, is offering to hire students into support positions such as transport and patient safety associate. The regional health care system also is tapping agencies to help fill vacancies for registered nurses and respiratory therapists.
Following the lead of Redstone, Excela plans to implement an international contract for registered nurses this fall, system spokeswoman Robin Jennings said.
UPMC and AHN advertised more than 2,200 openings for registered and licensed nurses online last week. UPMC, the largest employer in the state, is dangling recruitment bonuses of up to $10,000 for registered nurses. AHN is offering a signing bonus of $10,000 for registered nurses with a year of experience and up to $15,000 for more experienced nurses.
Jane Montgomery, chief operating officer for the Healthcare Council of Western Pennsylvania, said the pandemic created a whole new level of staffing problems in the region’s hospitals and skilled care nursing facilities.
In addition to salary competition from other industries, other challenges have affected the supply of registered and licensed nurses.
“You had people leaving the workforce because they were worried about getting sick and taking something home. And we had nurses leaving to work for agencies that were paying higher rates to staff facilities in areas where there were covid outbreaks,” Montgomery said. “And we’ve known our nursing population was aging. This may have pushed some of them into retirement earlier than they planned. Even before the pandemic, you had organizations that went overseas and brought in staff. With the pandemic, they couldn’t do that. I think it is probably a combination of all of those things.”
Claire Zangerle, chief nurse executive at AHN, agreed.
“This is a perfect storm with 10 things that has hit the labor market all at once,” Zangerle said.
“During the pandemic when there were hot spots due to excessive virus outbreaks, you saw nurses leaving and going to work for travel agencies to go and fill in for hospitals that were in worse shape than us,” Zangerle said. “It was hard for us to be angry about that. If a young nurse has the ability to do that and go and pay off school loans, then good for them. When they want to come back, we’ll welcome them. And we’re seeing nurses in those traveling positions start to come back home.”
Still, she allows that filling the void – AHN lists 590 nursing positions on its website, some of which Zangerle termed aspirational — is going to be difficult.
In 2018, AHN looked to the Philippines and Caribbean islands, which have similar professional standards, to recruit 150 registered nurses on three-year work visas. Zangerle said that program has been a success with a high retention rate.
AHN nurse recruiters are promoting the relatively low cost of living in Western Pennsylvania to potential job candidates from Eastern Pennsylvania, Ohio and New York.
“A lot of our work is focused on retaining the talent we have to stay at the bedside,” Zangerle said. “But our nurse recruitment team, their tongues are out. They are panting.”
Indeed, staff shortages are driving conversations across the spectrum in the health care industry.
“Safe staffing and taking care of our patients is the most important thing to us,” she said. “This is a super-important topic to address. Hearing about it might motivate somebody to say, ‘Hey, my daughter or son or granddaughter should consider a career in health care.’ The workforce in health care across the nation is literally in crisis.”
Deb Erdley is a Tribune-Review staff writer. You can contact Deb at 724-850-1209, firstname.lastname@example.org or via Twitter .