It was a busy night for caregivers in the skilled nursing facility at Oak Hammock, a retirement community connected to the University of Florida. Two new patients had been admitted who required immediate attention. Two long-term residents were having a difficult night, pressing their call lights repeatedly so the nurses’ aides would attend to them.
Their requests ranged from something falling on the floor, to complaints about pain, to help going to the restroom.
Lorraine Scott, 22, a certified nursing assistant, or CNA, was one of the staffers on duty. Although this night was unusually tough, Scott maintained her cool.
“If you like people, it is a good job to have,” Scott said. “A lot of coworkers are mothers, and it makes total sense. They have experience. You just need to know how to take care of other people.”
Scott and other young CNAs like her are helping to fill the gap in caregiving after the pandemic left many nursing homes and long-term care facilities short of staff. In some cases, homes were compelled to close. The situation has driven caregiving professionals and experts to a consensus view of the growing dilemma in Florida and across the country.
“I think we are in a huge crisis,” said David Grabowski, an expert in long-term care and health care policy at Harvard Medical School, who said it has simmered under the surface until now. “In some parts of the country, nursing homes can’t find the staff that they need. And family members are struggling to provide care for their loved ones.”
Grabowski said the care industry has yet to meet the challenge, with staffing at nursing homes still down by about 350,000 nationwide.
According to the U.S. Census Bureau, more than 56 million people—or about 17% of the U.S. population—are over age 65. Florida has among the highest shares, with 21% of the state’s 21 million residents over age 65. In Alachua County, 15.2% of residents are at least 65.
Those numbers are only going to increase in the coming years: Every day some 10,000 Baby Boomers turn 65, and 7 out of 10 are expected to need long-term care.
“We are not getting out of the crisis,” Grabowski said. “It’s a caregiving crisis, but also an affordability crisis. We need to allow individuals to make real choices. Our system now is a road to nowhere. Hard to navigate and not really a lot of answers. “
Family caregiving is increasingly popular as fewer nursing homes and long-term care facilities exist in the post-COVID era—and while the costs of long-term care continue to soar.
“It is affecting people’s ability to age in place or form aging communities,” said Susan C. Reinhard, a senior vice president at AARP, who directs its Public Policy Institute. She said outside of closures and affordability, the workforce shortages are also limiting choices: “It really and truly is a crisis, especially if you have no one to take care of you at home.”
Gainesville’s Elder Options is working to address the dilemma, offering training geared to family caregivers several times a month. The nonprofit organization, which services 16 counties in North Central Florida, also hosted a Nov. 2 conference on the future of caregiving to kick off National Family Caregiving Month.
Johnnie Jones III, Elder Options’ coordinator of caregiving training and support, said about 50 people attended that event, most of whom are informal family caregivers.
“We can highlight trends and legal matters, technology and assistive devices for family caregivers, things designed to make their lives easier and their caregiving journey less stressful,” he said. “The idea is to improve functionality so people can have better access and enjoy more things.”
Many people in Gainesville are already caring for their aging parents, and some of those caregivers are aging themselves. One Gainesville resident, already in her 60s has brought her 80-something mother into her home. She pays her granddaughter and a neighbor to help when she is at work.
But family caregiving comes with a price that goes beyond dollars. A report that Well Florida Council prepared for the Alachua County Department of Health in 2020 found that a growing aging population may lead to increasing caregiver burden, contributing to poor economic and physical well-being of caregivers.
Even Oak Hammock, the only five-star ranked skilled nursing facility in the Gainesville area, has felt the crunch, according to administrator-in-training Ashley Davis.
“During COVID staffing was horrendous,” she said. “You had to sometimes turn patients away because we didn’t have the staff to treat them. And you couldn’t bring them in because you didn’t meet the [government] ratios. We were at a point where we had to offer sign-on bonuses.”
She said Oak Hammock has now stabilized its staffing levels—but at a steep cost.
“The industry has changed so much in how we pay staff members, and it is constant driving things up,” she said. “Today’s world is very focused on the dollar. And I think that’s where the crisis lies.”
Costs for long-term care for an individual vary depending on the insurance one has, what insurance is accepted at the facility, and the care that is needed. According to the Genworth Cost of Care survey, the median cost of an assisted living facility in Florida last year was $48,000. The media cost of a private room in a nursing home was more than twice as high.
Oak Hammock’s skilled nursing facilities are open to patients in the community who have the insurance the facility accepts.
Davis’ colleague Michelle Parker, Oak Hammock’s director of nursing, agrees that staff pay is an important issue, but she says other factors also enter the equation.
“People have burnout with nursing, especially long-term care because there are so many rules,” she said. “At Oak Hammock, we are fortunate to have the staff we need. But I am hearing from other facilities it is harder to get the nurses and CNAs they need to come back.”
Parker notes other difficulties, including the fact that during the pandemic many nurses did not get hands-on clinical training because of restrictions and a growing tendency among providers to keep their patients out of long-term facilities.
“One of the challenges is that providers are avoiding post-acute care,” she said. “More and more they are recommending that people go home with home health.”
Scott, Oak Hammock’s young CNA, wants to go back to school to be a physician’s assistant. Like others, she is here to get clinical hours to help continue her studies but takes pleasure in what she is doing now.
“I like doing this,” she said. “I wanted to be in health care. That’s why I went to college. I was raised by an older lady, so this job is not that hard to do.”
While Scott plans to move on, many of her colleagues are older and have made careers out of being a nurse’s aide. Tamika Harkness has almost a year under her belt at Oak Hammock but has been a CNA for 16 years.
“I like the hands-on work and helping people and hearing their stories and getting to know them,” Harkness said. “The older they are, the wiser they are, and they can tell you some stories you’ve never heard before.“
Despite the commitment to care for many individuals in facilities like Oak Hammock, in home care, or family care, Florida still has a long way to go. The Sunshine State ranks last among all states in terms of long-term care and support, according to a 2020 study done by the AARP Foundation, the Commonwealth Fund, and the SCAN Foundation.
In Florida, nearly 80% of working people do not have access to paid family leave. Although the federal Family and Medical Leave Act is supposed to make unpaid leave available to the working population, more than half of Floridians can’t access it due to restrictions.
AARP’s Reinhard sees paid family caregiving as a possible solution for the future.
“In general, if you compare family caregiving to a nursing home, you can serve two to three people at home for the same cost as a nursing home,” she said. “And then you definitely have care around the clock.”
Editor’s note: This story is the first in a new series called Aging Matters. It was independently reported by Ronnie Lovler and underwritten by Elder Options. Some reporting was made possible by Lovler’s acceptance as a fellow into the 2022 Age Boom Academy, a program of the Columbia Journalism School, the Robert N. Butler Columbia Aging Center, and the Columbia Mailman School of Public Health.