Tag Archives for nursing home workforce

New Census data reports the graying of U.S. population 

Published in RINewsToday on June 26, 2023

The nation’s population continues to gray and this is documented by a series of demographic profiles from the 2020 Census recently released. The release of this updated census data must be a wake-up call to Congress and federal and state officials who oversee aging programs and services.

According to Zoe Caplan, statistician demographer in the U.S. Census Bureau’s Sex and Age Statistics Branch, the U.S. population age 65 and over grew from 2010 to 2020 at the fastest rate since 1880 to 1890. The nation’s over-age-65 population grew nearly five times faster than the total population over the 100 years from 1920 to 2020, says Caplan in a May 25, 2023 posting on the agency’s website.

In her posting, Caplan says that in 2020, a whopping 1 in 6 people in the United States were age 65 and over. In 1920, this statistic was just 1 in 20. 

The 2020 Census reported that the older population increased by 50.9 million, from 4.9 million (or 4.7% of the total U.S. population) in 1920 to 55.8 million (16.8%) in 2020. This represents a growth rate of about 1,000%, almost five times that of the total population (about 200%).

Growth in older population spiked 2010-2020

According to Caplan, the older population has been growing for the past century but the decade before 2020 saw its fastest increase since 1880 to 1890. “From 2010 to 2020, the age 65 and over population experienced its largest-ever 10-year numeric gain — an increase of 15.5 million people. The next largest 10-year numeric increase, 5.7 million between 1980 and 1990, was less than half that size,” she says.

From 2010 to 2020, Caplan stated that the 65 and over population experienced the largest-ever percentage-point increase, from 13.0% to 16.8% of the total population. “Before 2010, it took 50 years (from 1960 to 2010)  for the nation’s older population’s share of the total population to grow by the same number of percentage points,” she said.

The 2020 Census Data reveals that while the nation’s population grew from 2010 to 2020, the size and rate varied by age groups for other age groups. The 65 to 74 age group was the largest of the older cohort groups, with 33.1 million people, representing over half of the age 65 and over population (or 1 in 10 Americans), she said.

“The 65 to 74 age group experienced the largest growth of any older age group the previous decade,” says Caplan, noting that its numbers grew by 11.4 million or (52.5%), increasing from 21.7 mil­lion in 2010 to 33.1 million in 2020.  

Caplan says that the 75-to-84 age group grew at about half that rate (25.1%) but is expected to pick up the pace in the next decade as baby boomers age into this group. Additionally, she noted that the 85-to-94 age group had a relatively slower growth (12.6%) than other older age groups, increasing from 5.1 million to 5.7 million.  The population 95 years and over also expe­rienced a large growth rate (48.6%), increasing from about 425,000 in 2010 to 631,000 in 2020, she added. 

The 2020 date also indicated that for those people age 70 and over, males experienced a larger percentage growth between 2010 and 2020 (42.2%) than females (29.5%). Meanwhile, the percentage of centenarians have grown 50% since 2010, the fastest recent census-to-census percent change for that age group.  

Finally, while the U.S. population age 65 and over population grew, the Census 2020 data indicated that the nation’s population remained relatively young when compared with other nations. Caplan noted that Japan has the largest percentage (28.5%) of older residents.  Many European countries, along with Canada and Hong Kong, have larger percentages of older residents than the United States, says Caplan, noting that the United States ranked 34th (16.8%) among these places.

Japan had the largest share (28.5%) of older residents. The United States ranked 34th (16.8%) among these places. Many European countries, along with Canada and Hong Kong, had higher shares of older residents than the United States, adds Caplan.

Nation’s median age creeps closer to Age 40

Just last week, the U.S. Census Bureau reported that the nation’s median age increased by 0.2 years to 38.9 years between 2021 and 2022.  Median age is the age at which half of the population is older and half of the population is younger.

“As the nation’s median age creeps closer to 40, you can really see how the aging of baby boomers, and now their children — sometimes called echo boomers — is impacting the median age. The eldest of the echo boomers have started to reach or exceed the nation’s median age of 38.9,” said Kristie Wilder, a demographer in the Census Bureau’s Population Division in a statement released on June 22, 2023.

“While natural change, nationally, has been positive, as there have been more births than deaths, birth rates have gradually declined over the past two decades. Without a rapidly growing young population, the U.S. median age will likely continue its slow but steady rise,” she says.

According to the statement, a third (17) of the states in the country had a median age above 40.0 in 2022, led by Maine with the highest at 44.8, and New Hampshire at 43.3. Utah (31.9), the District of Columbia (34.8), and Texas (35.5) had the lowest median ages in the nation. Hawaii had the largest increase in median age among states, up 0.4 years to 40.7.

No states experienced a decrease in median age. Four states — Alabama (39.4), Maine (44.8), Tennessee (39.1), West Virginia (42.8), and the District of Columbia (34.8) — had no change in their median age from 2021 to 2022.

Can Rhode Island cope with a population growing older?  

“It is no secret that the Rhode Island population is growing older,” says Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, whose Subcommittee was charged with looking at Rhode Island’s older population, its demographics, services and programs to assist them to age in place in the community along with identifying gaps in services. “We issued a comprehensive report in 2016 showing that persons age 65 and over in Rhode Island would go from 14.4% of the state population in 2010 to 25% by 2040,” she said.  

According to Maigret, the US Census 2021 estimates shows the state’s 65 and over population is now at 18% and some its communities have already reached 20%. “Our older population is also becoming more diverse. White older adults went from 93.4% in 2010 to 86.4% in 2021 (RI Healthy Aging Data Report.) while Hispanic older adults increased from 3.8% to 6.5%. Our Subcommittee continues to work to implement recommendations we made in nine different areas important for aging in the community,” adds Maigret, noting that she has been working with advocates and legislative champions to implement and put them into law or practice.

“We have made some significant progress in expanding home care for those not impoverished enough to be on Medicaid, to expand respite services for caregivers and this year to fund the Office of Healthy Aging and Disability Resource Center. But we still have much more work to do,” says Maigret.

“I am especially concerned that studies show some 80% of persons age 65+ will not be able to afford two years of home care and many may need more than that. So that is something we need to address by changes in Medicaid and Medicare providing support for unpaid family caregivers who provide enormous amounts of long-term care to loved ones in need.  We also be providing more funding for local senior center programs that are shown to promote health and reduce social isolation with its negative health outcomes,” says Maigret.

Maigret says that funding for the Village Common of RI that, an organization that provides trained and vetted volunteers in local villages to provide supports such as transportation to medical appointments, grocery shopping, friendly visits, minor home tasks — all types of supports to help older adults remain in their own homes, should also be allocated. “More communities are interested in starting these types of volunteer programs of mutual support but funding is needed to support the infrastructure,” she advises.  

Maigret expresses concern that so many older Rhode Islanders are economically insecure. Twenty seven percent of older households are living on less than $25,000/year yet it costs an older Rhode Island couple in good health renting their home about $41,448 annually to meet basic living expenses (Elder Index).

“Economic insecurity is a special problem for older women who comprise 56% of the state’s 65 and over population and are more likely to live alone,” she says noting that their average Social Security checks amounts to $11,584 compared to $14,578 for men, and mean personal income for women is about $25,000 less than older males.

Maigret encourages state leaders to pay attention to these “age-related” demographics as they consider budget and policy priorities. And she would like to see each of the state’s communities assess their age-friendliness, like Newport, Cranston and Providence have done.” Other communities should follow Pawtucket’s lead of promoting fitness for older adults by creating  adult outdoor exercise area adjacent to its senior center or in local parks.

Addressing the State’s Shrinking Health Care Workforce

“The main focus in addressing issues related to meeting the needs of the state’s growing older population is to address the critical need for a robust healthcare workforce,” says John Gage, President & CEO of the Rhode Island Health Care Association.  “Reimbursement must support appropriate staffing levels at livable wages throughout the long-term care continuum – home care, assisted living residences and nursing facilities,” he says. 

“As the generations shift, there will be a greater need for long-term care supports and services with a shrinking workforce.  Sustainable funding is essential to the ability to provide this care, and it has never been more evident than today,” warns Gage.  “In the wake of the Covid-19 pandemic, current statistics from the U.S. Bureau of Labor Statistics indicate that Rhode Island’s nursing home workforce is down some 20% from pre-pandemic levels,” he says, stating a detailed analysis of the workforce for hospitals and nursing homes indicates that  nursing home RNs have declined by 16.5%, LPNs by 18.3% and CNAs by 25.4%.  It is estimated that, nationwide, recovery of the nursing home workforce will not occur until 2027 based on the small, incremental improvements quarter over quarter, adds Gage.

“Presently, 17% of our neighbors are aged 65 and older, and nearly a quarter (24%) are age 60 and above!  Recognizing this trend, we are actively engaged in anticipating and meeting the needs of our growing population of older adults in our state,” says Director Maria Cimini, of the Rhode Island’s Office of Healthy Aging.

“At numerous State and non-profit spaces, we are present to ensure that the needs of older adults are central to discussions surrounding  health care, housing, transportation, education, accessible communities, and caregiving,” she adds.

“We embrace the opportunity presented by the recently passed Legislative Commission to Study the Services and Programs for Older Adults to collaborate with Rhode Islanders working with seniors. Together, we will share our experience with aging populations, promote valuable resources, and identify what we all need to make RI a great place to grow up and grow old,” says Cimini.

For a copy of the 2020 Census Brief, “The Older Population: 2020,” go to https://www2.census.gov/library/publications/decennial/2020/census-briefs/c2020br-07.pdf.

For a copy of the LTCCC’s Aging in Community Subcommittee June 2016 Report, “Aging in Community” go to  https://www.rilegislature.gov/Reports/AiC%20Full%20Final%20Report%206.13.16.pdf.

For a copy of the LTCCC’s Aging Community Subcommittee December 2016 Strategic Plan, “Aging in Community, go to https://www.rilegislature.gov/Reports/Building%20an%20Age-Friendly%20Community.pdf.

For a copy of Rhode Island Healthy Aging Data 2020 Report, go to

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Nursing home workforce crisis deepens with minimum staffing standards

Published in RINewsToday on February 13, 2023

“The long-term care industry is enduring the worst workforce crisis in its history, in Rhode Island, and across the country. Although providers are committed to recruiting and retaining staff to provide quality care for residents, despite our best efforts, many nursing homes have fallen short of the staffing ratio set by the RI Department of Health,” notes James Nyberg, Executive Director of the East Providence-based Leading Age Rhode Island (LARI), representing nonprofit providers of aging services.

“We are extremely  concerned about the impending fines that will be imposed on nursing homes here in Rhode Island as a result of our state’s existing nursing home minimum staffing ratio statute,” said Nyberg. Because of staffing ratio mandates, “the industry would have faced fines of over $11 million, in just one sample quarter (April – June 2022), since over 70% of nursing homes are not in compliance,” he said.  

“While April-June was a sample, the fines go into effect for July-September and we will receive a similar notice in just a few weeks, with only 10 days to pay the fine,” says Nyberg, stressing that these fines will only increase going forward if nursing homes are unable to meet the minimum staffing ratio.

Nyberg calls on the Rhode Island General Assembly to rescue Rhode Island’s nursing homes and provide relief from these penalties by delaying them and exploring an alternative approach to support the efforts of nursing homes to meet the ratio.  He warns that the current fine-based approach is excessive and counterproductive and will lead to reduced access to care and threaten the survival of the state’s nursing homes.

Nyberg points out that the current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (five nursing homes have already closed since the COVID pandemic began).  These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes.  

“We are working with numerous stakeholders on various initiatives to develop a pipeline of workers, but the simple fact is that it will take time.  In addition, as you know, the industry has faced years of underfunding from Medicaid, which pays for the majority of nursing home care.  This has made recruiting and retaining workers more difficult than ever,” says Nyberg. 

John Gage, President of the Rhode Island Health Care Association (RIHCA) agrees with Nyberg’s assessment of the nursing home workforce.  “Nursing homes across the nation are facing an historic labor shortage as the direct result of chronic Medicaid underfunding and the devastating impact of the Covid-19 pandemic on the workforce, he says, noting that the state’s nursing home workforce is down 20% since the start of the pandemic, with 2,000 workers lost from Jan. 2020 to June 2022.  Nationwide, the nursing home workforce is down 210,000 workers.

According to Gage, Rhode Island’s staffing mandate, while well-intentioned, will siphon tens of millions of dollars from resident care. In the first year of full implementation of the state’s minimum staffing mandate, RIHCA estimates that facilities will be fined upwards of $60 million. “These fines will imperil care, not bolster it,” he warns.  

Without legislative action, Rhode Island nursing homes will be fined an estimated $11 million on or about February 28, 2023, because of their inability to attract workers to meet the mandate from July 1, 2022, through September 30, 2022, Gage charges. “There are simply not enough available workers to fill the open staff positions, and resources are scarce.  Nursing homes will be devastated by these fines.  Facilities will reduce admissions, backing up hospital referrals and clogging hospital beds.  More nursing facilities will close – five have already closed since the beginning of the pandemic,” he predicts.  

Gage asks, “Who will care for Rhode Island’s frailest elders?” To recreate a minimum staffing mandate in nursing homes on the federal level would be a huge mistake, especially given the historic workforce crisis here in Rhode Island and nationwide,” he says.  

Gage’s comments echo concerns expressed by another group of US Senators in Jan. 20 correspondence (https://www.tester.senate.gov/wp-content/uploads/1-20-23-Nursing-Home-Staffing-Mandate-Letter-FINAL.pdf) sent to CMS by Senators John Bourasso, Jon Tester, and eleven other US Senators.  They caution the agency that a one-size fits all mandate would undermine access to care for patients, and they encouraged CMS to work with Congress on tailored solutions that address the workforce challenges facing nursing facilities.

At the federal level

Just days ago, U.S. Senators Bob Casey (D-PA), Chairman of the Senate Committee on Aging, and Ron Wyden (D-OR), Chairman of the Senate Finance Committee, called on the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to encourage the federal agency to establish minimum staffing standards in nursing homes to ensure high-quality care for nursing home residents. In Feb. 10 correspondence, Casey and Wyden, along with Senators Sherrod Brown (D-OH), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Cory Booker (D-NJ), and Elizabeth Warren (D-MA) urged CMS to advance the agency’s ongoing study to determine adequate staffing requirements in nursing homes.

“We appreciate the work that CMS has undertaken to promote safety and quality in nursing homes and applaud the Biden-Harris Administration’s commitment to protecting our nation’s seniors,” said the senators in Feb. 10 correspondence, urging CMS to “bring this work to completion.” 

“In our view, that means continuing the agency’s ongoing study to determine the level of staffing that is necessary to ensure safe and high-quality care for nursing home residents, developing an evidence-based and actionable proposal for mandatory minimum staffing levels, and a robust and transparent process—including direct stakeholder engagement— that will allow for further discussion and fine-tuning of requirements before the proposal is finalized,” wrote the senators.

The senators noted that studies have shown a correlation between inadequate staffing levels and lower quality of care. More recent studies have demonstrated that higher nurse staffing ratios mitigated the effect of COVID-19 outbreaks in nursing homes and resulted in fewer deaths. A recent Department of Health and Human Services Office of Inspector General report examining the high level of COVID-19 infections in nursing homes also pointed to the need for the establishment of minimum staffing requirements.  

In the correspondence, the senators cite the Social Security Act, which requires skilled nursing facilities to “provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents,” including the services of a registered nurse at least 8 consecutive hours per day, 7 days a week. The letter commends CMS for working to update this vague standard that has led to substantial variation in staffing levels and quality of patient care across facilities.

“Achieving the shared goal of ensuring quality care in nursing homes nationwide is a complex undertaking, says LeadingAge’s Ruth Katz, senior vice president, policy. LeadingAge is an association of nonprofit providers of aging services, including nursing homes.

“As our Get Real on Ratios proposal highlights, a number of conditions must be met in advance of any mandate implementation,” suggests Katz. “The senators correspondence to CMS is a promising development; it covers many of the same points as our Get Real on Ratios proposal – a recognition of the critical need for adequate reimbursement; that one size does not fit all, and that workforce shortages will need to be addressed with additional support. Without addressing these, staffing mandates are impossible. We look forward to continuing our discussions with Congressional leaders on this critical issue so that older adults and families can access much-needed care and services,” she says.

“The Senior Agenda Coalition of RI fully supports the need to develop national staffing standards to ensure quality care is provided to nursing home residents across our nation. It is important to note that Rhode Island has been a leader in this area. For many years our state has required 24/7 RN coverage in nursing homes and in 2021 the legislature passed the Nursing Home Staffing and Quality Care Act that includes staffing standards,” says Maureen Maigret, Policy Advisor to Senior Agenda Coalition of RI. “Now we must work to address workforce shortage issues and ensure that adequate government resources are provided especially through Medicaid payments so the standards can be met, and our critical direct care workers receive competitive living wages in order to keep them working in long term care,” she adds.

As the House Leadership hammers out the FY 2024 budget, it is crucial that adequate Medicaid funding is allocated to allow nursing homes to attract the necessary staff to meet the state’s minimum nursing standards that it codified into law. We must address this policy problem now rather than just kick the can down the road.