The Centers for Medicare and Medicaid Services logo.
The Centers for Medicare and Medicaid Services logo.

Staffing is a constant, top-of-mind concern for skilled nursing facility operators. This is a people business. We deliver health care. Adding to the challenge, we are now delivering that care to more medically complex patients than we did 20 years ago. We need compassionate and skilled employees to do this work. Our staff are the backbone of everything we do to care for residents and patients. 

Recruiting and hiring great staff are priorities for Commonwealth Care of Roanoke, as well as other providers like us. We have made a commitment to be a competitive employer by offering wages and benefits to attract and retain individuals to work in our centers, including flexible schedules and tuition assistance. Like all health care providers, we had staffing challenges before Covid. These worsened during 2021. Since then, staffing has improved, but not to the levels we had before the pandemic. Even with concerted recruiting efforts, we still have vacancies. The truth is the workforce simply is not there and this is no time to consider a staffing mandate.

We want to orient and train our own staff. We have been investing in their careers and promoting their relationships with our patients because consistency in staffing is key to great outcomes for residents. It’s CCR’s mission to take care of the “whole” person not just provide their needed medical care. Having employees who embrace our culture and understand our values is the best way to provide the highest level of care.

These staffing issues are compounded by the fact that Medicaid reimbursement rates do not allow us to do what we want to do to care for our residents and patients. The Medicaid program in the Commonwealth does not cover the full cost of care for every nursing center resident enrolled in the program. This is significant because the vast majority of our residents rely on Medicaid to pay for their care. In other words, other payer sources must subsidize Medicaid’s underfunding for nursing centers to just break even, which is increasingly challenging. Unlike other businesses, nursing centers cannot simply raise our rates when we incur higher expenses caring for the majority of our patients.

If we want quality staff, we need to recognize that our caregivers require a special skill set. We cannot compete with the retail and hospitality sectors for employees. Exploring training opportunities with community colleges and universities, as well as our secondary education system which can serve as a pipeline for training more nurses, is an essential step we need to take today. We are excited to be a part of the Blue Ridge Partnership for Health Science Careers, which is committed to improving health sciences education and aligning instruction to meet the workforce needs of the region’s health employers. We need to support partnerships like this and expand them to other areas of the state. 

We also need to work on reversing situations when nursing programs have to turn away interested applicants because they do not have enough instructors. Some RNs have made the choice to work as a travel nurse for higher wages than they can earn teaching the next generation of nurses. There are also programs that have to cap participation because they do not have enough space or equipment to meet the demand for those who want this training. The healthcare system will benefit when providers across the healthcare spectrum, education institutions, and our state policymakers work together on these issues. 

We need to put providers in a position where they can get the staff they need. That will take a commitment to fund the Medicaid program, to build a talent pipeline of individuals who want to work in long term care, and to establish career pathways that grow the number of individuals with the necessary skills and expertise. We need a multi-faceted approach to address the complex issues around the nursing center workforce and Medicaid underfunding of nursing care, not an unfunded federal staffing mandate.

Deborah L. Petrine is Chairman and CEO of Commonwealth Care of Roanoke, which operates 12 skilled nursing...