The Staffing Crisis: How it Ends

Let’s talk about the Staffing Crisis.

Skilled nursing is struggling to find people to do the work we’re here to do: care for people who need us. All clinical positions are in demand. Everyone in the field I speak with talks about it.

How Did We Get Here?

Skilled nursing isn’t like most businesses. We really only have a handful of payers, or ultimately, customers. State and federal government make up the majority of our customers. In some cases the government is the vast majority payer. This makes the operating environment different.

In most businesses, the law of supply and demand as you normally understand it applies. If the cost of raw materials or labor increase, we have few choices. If the increase is small, we can choose to make less profit. If the increase in expenses is high enough, we must increase prices. It’s day one, freshmen year, economics.

In skilled nursing, our major customer is so big and powerful it can unilaterally change the price we charge for service. Not only can it change the price it pays at any time, it can also do that retroactively. Or demand a refund of greater than 100%. It can show up at any time to see if we’re following all the rules it created. Then, it goes on it’s own version of Yelp! and posts the only review.

Since you can’t just simply raise prices to cover the cost of increased labor expenses the workforce simply goes elsewhere. The value of working in skilled nursing is less than some other option.

I had a smart person tell me “There simply aren’t people to hire.” That’s not true at all. There aren’t people to hire at the wage you are willing and able to pay. If you offered $100/hr for a CNA, people would show up. But since you can’t raise prices, you’re stuck.

Idea: Let’s FINE our way out of a staffing shortage!

So, given that information, fining buildings that don’t meet an arbitrary staffing target seems to lack understanding of basic economics. That’s the direction we’ve chosen however.

Worse, our majority customer is constantly threatening to lower our prices.

In short, it’s tough out there.

This has caused many people to freeze all activity regarding partnerships and evaluating new technology. This is exactly the wrong response. You see, this current, difficult operating environment is our current and foreseeable new reality. THIS is what we’ve been given to work with. This is your life.

Don’t stop trying to improve: your care, your outcomes, your documentation and even your reimbursement, even during the difficult times. If your partnerships aren’t working, change them. If there is a new technology that will make you better, try it. Things won’t get better without you forcing the issue.

Patient needs aren’t going to stop or diminish.

So how exactly will the staffing crisis end? It ends when we all stop calling it that and learn to work in whatever challenging operating environment we find ourselves in. The next major challenge may be here soon.