The need to solve California’s caregiver shortage

Nothing clarifies the necessary components of a system like a crisis. The past year of fear, isolation and grief has produced some invaluable lessons about who cares for and about our older adults. 

After more than a year of managing through the COVID-19 crisis, nonprofit nursing facilities have experienced a lack of access to Personal Protective Equipment, navigated unprecedented resident social isolation and are now confronted with an all too familiar challenge – finding enough compassionate, empathetic and skilled staff to provide older adults with the care they need and deserve.

As we look to address what is accurately called a skilled nursing facility workforce emergency, we must seize the learning gleaned through the pandemic and act immediately to restructure our caregiving workforce with common sense solutions.

Early in the pandemic, California acted swiftly to ensure that older adults were properly cared for by implementing emergency relief for staffing ratios and creating National Guard “Strike Teams” to help fill long-term care staff shortages. It was a smart, effective move that made a big difference.

Now, as nursing shortages at health care facilities statewide reach a crisis point, we are urging the state to reinstate the flexible staffing ratio, reconstitute the “Strike Teams” and allow skilled nursing facility staff like student nurses and personal care attendants to practice at the top of their licenses, and be included in any ratios.

While we take these steps to address immediate needs, we can’t lose sight of why finding the staff needed to provide quality care to older adults has proven so problematic. The lopsided ratio of certified nursing assistants to licensed vocational nurses and residential nurses – a requirement that exists only in California – is emblematic of the broader issues that drive the caregiver workforce shortage and lead to worse patient outcomes.

While well-intentioned, requiring a specific number of CNAs be present for each additional LVN or RN on duty creates an illogical bottleneck. Additional staff with more advanced levels of certification provide better care for patients – meaning grandparents, great aunts, uncles and loved ones won’t suffer insufficient care simply because of an unworkable, illogical ratio.

These inconsistencies outline the scope of California’s caregiving workforce shortage, which is dramatic. Personal care aides are expected to be the single largest occupation in California by 2026 and that growth will contribute to a statewide shortage of up to 3.2 million paid direct care workers in coming years.

This workforce crisis threatens the quality and affordability of care for aging Californians. In just nine years, the number of older Californians will double, comprising a full quarter of the state’s population. We must rethink our approach to caregiving to ensure our older adult care system is resilient to future public health crises and can support our rapidly graying population.

It is through the pandemic that a logical path forward has been revealed. We know we need to address lopsided ratios. We also know what needs to be done to reduce the artificially high barriers to entry for a workforce comprised mostly of women, many Black, Indigenous, Latino and Asian American, and who are twice as likely as other Californians to live in low-income households. Creating additional online training pathways and accelerating the adoption of technology to help relieve staffing pressure are just two. 

By restructuring our caregiver workforce and applying the insight and learnings gained from the COVID-19 pandemic, California state government leaders have an immediate opportunity to take steps that will ensure all older adults have access to the care they deserve and provide staff with clarity and relief. Don’t let this moment pass without taking logical, commonsense action.