More than three-fourths (78%) of nursing home operators and top managers don’t expect the workforce to return to pre-pandemic levels for at least another year — if ever.

That’s just one of the stark findings from the McKnight’s 2022 Outlook Survey, in which industry leaders reported feeling largely pessimistic heading into the new year.

Leaders also remained highly concerned about rebuilding census, tighter regulatory compliance and Medicaid reimbursement rates.

McKnight’s Long-Term Care News garnered 317 responses from nursing home owners, administrators and top nurse managers who filled out online surveys from Dec. 10 to Dec. 30.

After two years of pandemic conditions, a majority of respondents continued to be somewhat satisfied with their jobs, giving an average rating of just under 6 (out of 10), though that represented a slide of about 12% from a year earlier. When asked about optimism for the industry as a whole, only 19.8% said they were more optimistic about what 2022 will have in store.

About 58% were less optimistic about 2022, and 22.4% expected a “neutral” outlook.

“Skilled nursing leaders no longer see the light at the end of the tunnel,” said Cara Silletto, president and chief retention officer of Magnet Culture, a recruiting and retention firm serving the skilled nursing industry. “The tunnel is getting darker and deeper. No one sees the end of the pandemic in sight.”

The survey found that 98% of respondents said “having enough staff” was a top-four concern, 10 percentage points higher than a year earlier.

Meanwhile, worries about census eased a bit, with 61% of respondents listing it as a top-four concern, versus 82% a year ago. Expectations about when pre-pandemic census levels might return, however, slid heavily during the last 12 months.

Nearly 75% of operators had to limit admissions in 2021 without enough staff to serve all would-be residents, and 60% expected to do so again in 2022.

Notably, 50% said skilled census likely wouldn’t match pre-pandemic levels until 2023 (28%) or 2024 or later (22%).

More agency staffing ahead

The needs for contract and agency staffing could actually worsen, according to survey respondents.

About 39.4% said they expect to use more temporary staff in 2022, and another 26.2% said they would use the same amount. Another 9.8% expect to use less, while 24.6% of respondents said they do not or will not use contract or agency workers.

Meanwhile, worries about tighter compliance and more regulation came in as the third-most common top concern, with 56.8% checking that box.

As for how long staffing challenges will last, providers aren’t optimistic. Many have lost confidence since last year’s survey.

About 21.5% thought they’d get back to full staffing levels sometime in 2022. But more than two-thirds envision labor shortages lasting longer. About 22% predicted a 2023 recovery, while 31% said 2024 or later and 25% said never.


Signs of hope

Amid the negatives, some found a modicum of hope. Fifteen percent said their buildings had already returned to pre-pandemic census levels, with about 12.4% expecting to do so in the first half of 2022 and 20.5% in the second half.

Returning to full operations also has been a relative bright spot for many respondents, although overall expectations were tempered during the last 12 months. In late December, 26% said they had already resumed all normal activities, including group dining, visitation and day trips.

Another 37.6% anticipated they will in 2022. Many providers — nearly two-thirds — said they stand ready to add new or expanded services in 2022.

More comprehensive results can be found at mcknights.com.

From the January/February 2022 Issue of McKnight's Long-Term Care News