The Impact of the Nursing Shortage for those with Disabilities

In 2018, the American Journal of Medical Quarterly projected a shortage of nurses between 2016 and 2030 that is expected to be experienced most intensely in western and southern states. The nursing shortage is not a new phenomenon; its repercussions are evident not only in at-home care, but in hospitals and clinics as well, having a negative effect on both patient care and access to healthcare. Studies show that there is a strong link between adequate nurse staffing and better patient outcomes. An increase in a nurse’s patient workload can lead to the greater likelihood of a patient dying in the hospital or an increase of hospital readmissions. Higher staffing results in fewer deaths, lower failure to rescue incidents, lower rates of infection and shorter hospital stays. There is also a connection between a nurse’s education and patient care; more nurses with baccalaureate and doctorate degrees leads to fewer patient mortalities.

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The nursing shortage is not a new phenomenon. Studies show that there is a strong link between adequate nurse staffing and better patient outcomes.

While the current shortage of registered nurses is felt by everyone, the decrease in available skilled nursing care has been especially hard on children and adults with disabilities and their families.

Over 4 million Americans with illnesses and disabilities are cared for at home by nurses, therapists, or other home health caretakers. Some older adults and people with disabilities have already been struggling to find reliable at-home care and the pandemic has exacerbated the situation. Adults with disabilities who previously led a fairly independent life with minimal outside assistance may be forced to move to an intermediate care facility. Though the majority of these patients are older, many are children with serious medical conditions who require round-the-clock care. The shortage of home-care providers is occurring all over the country, compelling parents and other family members to take responsibility for relatives who were normally cared for at home by a nurse or a home healthcare worker.

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Without the assistance of a registered nurse, family members are stressed out and afraid of making mistakes.

Children with the most serious conditions have the most trouble finding care leaving parents with no choice but to shorten their work hours or tag-team to care for a needy child in shifts. Family members caring for a relative wonder if there isn’t a way to get paid for caregiving. These people aren’t looking for a handout; they simply want to find a way to pay their bills. Some people even consider enrolling in nursing school so they can earn a living while caring for a family member.

Unfortunately, there are very few government programs that will pay a family member or friend who is providing care on a regular basis.

In most cases, state Medicaid programs bar people from getting paid as caregivers for relatives, and Medicare will not pay for long-term care services like in-home care or adult day care. It doesn’t matter if the care is provided by a direct care worker or a family member. There are programs in some states, like Colorado, that allow family members who become Certified Nursing Assistants (CNAs) to be reimbursed through a licensed home care agency for providing CNA level care through Medicaid and a few states that have programs for people who do not qualify for Medicaid.

There are many factors driving both the nurse shortage and the shortage of home healthcare providers, not just the Covid-19 pandemic.

The Covid-19 healthcare crisis prompted 29 percent of healthcare workers to consider leaving the profession.
Reasons include:

•    Nurses leaving the work force to care for their own children who were out of school or another family member.
•   Nurses becoming sick themselves and having to quarantine.
•   The high demand for nurses to fill positions at hospitals, Covid-19 testing sites, and vaccination centers.
•   Lower wages for home care nurses. A nurse earning $40 per hour in home healthcare can earn $75 per hour administering vaccines, and home healthcare agencies may not provide benefits like health insurance.
•   Nursing schools are struggling to train nurses and meet the demand for skilled nursing care. Not only is enrollment not growing fast enough to meet the demand, but there is a shortage of qualified faculty.
•   A significant number of nurses are retiring or nearing retirement age. The average age of a registered nurse is 50. Health Affairs blog projected in 2017 that one million nurses would leave the profession by 2030.
•    Nurses are leaving the profession due to stress caused by inadequate nurse staffing and low job satisfaction. Many are simply “burned out.”

The Bureau of Labor Statistics lists Registered Nursing as one of the top occupations for job growth through 2029.

The RN workforce is predicted to grow from 3 million in 2019 to 3.3 million in 2029, an increase of 221,900; 175,900 openings are expected yearly through 2029.

What can be done to increase the skilled nursing workforce available for patient care at home, in hospitals, and other facilities?

•    The wage gap between home healthcare and care at other medical facilities must be narrowed and benefits like health insurance should be provided.
•   A group of Democratic lawmakers has proposed a bill to require coverage of home and community-based services under Medicaid.
•   Many states have instituted programs to fund fellowships and loan forgiveness for nurse faculty who agree to teach in-state after graduation.
•    Some nursing schools are forming partnerships with various organizations to fund faculty, expand clinical placement sites or focus on a specific segment of the population, for example, Veterans.
•   The American Association of Colleges of Nursing has expanded its Nursing CAS, the centralized application service for RN programs to ensure that all vacancies at nursing schools are filled.
•   Other industries are also contributing to the effort. For example, Johnson & Johnson initiated its Campaign for Nursing’s Future, a public awareness campaign to recruit nurses and nurse faculty and help keep nurses in the profession.

Though the nursing shortage has been ongoing for more than a decade, these propitious steps show promise to recruit more people to this demanding profession and make sure they stay.

Hopefully, with new government programs and private initiatives providing more public health benefits, people with disabilities can look forward to living more independent lives again.