Guest Editorial: Proposal To Address Nursing Home Staff Shortages May Not Be The Cure The Feds Are Looking For

By Jaime Roberts and David Voepel

Thirty-six percent of Arizona’s population is seniors – more than 2.5 million residents. Of those 2.5 million, thousands are residents in our long term care facilities. It takes an army of devoted caregivers to look after our seniors, and their commitment to serve is unmatched.

The long term care profession is at a critical junction. Many of the long-standing challenges that have faced our sector have been magnified as a result of the pandemic, particularly as it pertains to our workforce.

In the last three years, health care workers have exited the field en masse, especially in our nursing homes and assisted living communities. Among all health care sectors, long term care experienced the worst job loss – and unfortunately, we are a long way from fully recovering.

Record-high inflation has led to skyrocketing costs, while chronic underfunding persists. Despite nursing homes taking every measure to rebuild their workforce, nearly every facility in the country says it’s still difficult to recruit new caregivers. When you factor in a national shortage of nurses that is only going to get worse in the coming years, it’s easy to see why. In fact, Arizona is projected to be the fifth worst state for nursing shortages by 2030.

Staffing shortages are leading to devastating outcomes. The Wall Street Journal reports that the number of nursing homes are decreasing. There are 600 fewer nursing homes in the U.S. today than there were just six years ago – a staggering number when we pause to consider how thousands of our most vulnerable citizens have been uprooted from their homes and left to search for new care.

Yet another threat looms large. President Biden’s administration is preparing to set a federal staffing mandate on nursing homes, which would impose an arbitrary staff-to-resident ratio for every facility. No matter how well-intentioned, the reality is that this one-size-fits-all regulation will have significant consequences for Arizona seniors and their access to care.

Most nursing homes are already reducing their census because of labor shortages. Nearly half of nursing homes have days-long waitlists. Hospitals are calling nursing homes so they can discharge patients to their care but are told they can’t take them. This will continue under this proposed mandate. It’s estimated that nearly 450,000 nursing home residents are at risk of displacement if facilities can’t boost their staffing levels to meet the mandate’s requirement.

As the number of nursing homes dwindle, Americans are living longer. Data from the 2020 U.S. Census shows that the population age 65 and older grew between 2010 and 2020 at the fastest rate since 1880 to 1890. Today, one in six people are over the age of 65. This presents a fundamental question: who is going to be there for our seniors when they eventually need long term care?


Imposing a broad federal regulation on nursing homes does nothing to solve the baseline cause of our workforce crisis. If lack of qualified and available candidates is the primary obstacle to hiring caregivers, then the better approach is developing solutions that will build a stronger pipeline of skilled workers.

To do that, we need a partnership with policymakers. Working together, we can create comprehensive solutions to these complex problems. There are plenty of ideas on the table, but we need lawmakers to put them into action.

Common-sense immigration reform that enables us to bring international nurses to the U.S. to work quickly is a step in the right direction. There are thousands of nurses overseas who are willing and eager to bridge our labor gaps. We need to lift the green card freeze, remove the bureaucratic red tape and get these workers to the states.

We need to reach the next generation of caregivers by going into our high schools and teaching them about the value and reward of working in long term care. Providing financial incentives to choose this career path, whether it’s wiping away student loan debt or giving providing tuition assistance for students who commit to working in long term care, will attract more talent to our profession.

We cannot wait for this situation to get worse before we act. Lawmakers in Washington, D.C. must prioritize our seniors and the long term care profession. Senators Kelly and Sinema should be front and center to lead the way.

Jaime Roberts is the incoming CEO of Arizona LeadingAge. David Voepel is the CEO of the Arizona Health Care Association.