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LTC Bullet: LTC Nursing Shortage Looms

Wednesday May 9, 2001


The April 2001 issue of Provider Magazine reports on a recent study by the American Health Care Association (AHCA) which foresees serious nursing shortages that will likely affect access to long-term care services.

Between 1991 and 2020, the AHCA study predicts the following growth in demand for nurses and nurse assistants:

*nursing facilities: registered nurses 66%; licensed practical and vocational nurses 72%; nurse assistants 69%.

*home health settings: registered nurses 270%; licenses practical and vocational nurses 2 68%; nurse assistants 263%.

According to the study, "there will not be a sufficient workforce available in the coming years to maintain even the current staffing levels in skilled nursing facilities. This staffing shortage can, in turn, lead to a declining availability of services and introduce a problem of access to care for those, particularly the elderly, requiring long-term health care."

In addition to retirement as one of the contributing factors, the study noted the significant wage differential between long-term care and acute care employers. The average nurse working in a long-term care facility earned 17% less than a comparable nurse working in an acute care hospital in 1996, according to the study.

The Center for Long-Term Care Financing finds this prediction of a nursing shortage troubling, but not at all surprising. As long as skilled nursing and home care providers remain so dependent on insufficient government reimbursement, meeting future staffing needs will be a herculean task. In addition, the looming prospect of federally mandated staffing ratios without additional money to pay for them only makes matters worse.

The coup de grace, in fact, may be the impact of mounting jury verdicts against long-term care providers for allegedly negligent care tied to poor or inadequate staffing. In Florida and Texas, for example, huge verdicts and settlements have caused liability premiums to skyrocket and some skilled nursing providers to exit the market or go without any insurance.

Is there a way out of this mess? Yes. Providers need to attract more private payers, insured or otherwise, who are paying a fair price for the value of care received. (Medicaid pays approximately 80% of the private pay rate and often less than even the cost of providing the care.) Today, skilled nursing providers are often lucky to have enough private pay patients to offset their Medicaid losses-leaving little or no money to invest in staff and facilities. In time, as providers transition to a mostly private pay census, the infusion of private dollars will empower them to attract enough capable and motivated staff to meet the predicted demand. Simply put, "You get what you pay for." Well-staffed long-term care providers are no exception.

The Center for LTC Financing's "LTC Choice" proposal explains how providers can achieve this outcome. The Center's report, "LTC Choice: A Simple, Cost-Free Solution to the Long-Term Care Financing Puzzle" is available at You can also order a hard copy ($24.95; free to lawmakers and media) by contacting Sarah Allen at with your complete contact information.

Source: Nathan Childs, "Nursing Shortage Could Impact Long-Term Care Access," Provider, April 2001, p. 12.