Help with Staffing Burnout


The Biden Administration is providing over $100 million in federal relief funding to address burnout among healthcare workers. The nursing home industry causes burnout with the short-staffing the facilities. Unsafe staffing affects the residents AND the caregivers. The new funds will invest in three different programs. These programs help staff respond to stressful situations, avoid burnout, avoid substance abuse, and promote mental health.

What they really need is safe staffing levels with competent and compassionate managers. Stress and burnout levels reached severe levels for long-term care workers. It can also stoke feelings of fear and isolation, prevent close ties with staff and foster a loss of dignity. Employees have repeatedly requested higher staffing levels. Caregivers are unable to spend adequate time with residents when stretched thin.

Lower staffing levels equate to fewer hours of direct care with residents. Lower staffing levels can lead to malnutrition, dehydration, unplanned weight loss, injuries from falls and avoidable declines in mobility.

The American Health Care Association and National Center for Assisted Living support providers who make COVID-19 vaccinations for healthcare workers a condition of employment. That should help relive some stress and increase recruitment and retention.

4.1 Can Be Done

Twenty years ago, a CMS study proved that 4.1 hours per patient day or HPPD is the bare minimum for safe staffing. However, CMS refused to mandate that number. Robyn Grant is director of public policy at the National Consumer Voice for Quality Long-Term Care, an advocacy group based in Washington, D.C. She now argues:

“When we say 4.1 hours, that is really probably on the low side, because that [CMS report] was done in 2001. The needs of residents have absolutely increased, and they’ve become much more medically complex. We have many more residents now with dementia. There are more individuals who need supervision and monitoring. So if anything, that number is lowballed. And despite that, there’s still amazing pushback.”

The national average stood at 3.47 in the final quarter of 2020. South Carolina nursing homes average less than 3.1. However, at least five states and the District of Columbia require above 4 hours of direct caregiving per day: Alaska, California, Hawaii, North Dakota and Oregon. Many other states have bills increase the minimum number closer to 4.1.

Anna Doroghazi is the associate director of advocacy and outreach for the AARP in Connecticut, which recently pressed for the increased hours.

“There’s definitely still work to be done. I think we understand that sometimes progress has to be incremental. It would have been ideal and better for nursing home residents, and probably the staff as well, if we had seen the increase all the way up to 4.1 hours.”

So experts and advocates all know that we need a minimum of 4.1 hours per patient per day of direct nursing and custodial care but refuse to mandate it. Really?

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