HARRISBURG — Struggles persist for health care administrators seeking to hire providers in hospitals and nursing facilities across Pennsylvania, according to a newly released industry survey, leading to greater difficulties for patients and their loved ones seeking immediate and long-term care.
Wait times at hospital emergency departments are growing as are backlogs for scheduling appointments and procedures, about 7 in 10 respondents said for the latest workforce survey from the Hospital and Healthsystem Association of Pennsylvania (HAP).
Nearly 3 in 10 hospitals eliminated or scaled back services and 2 in 10 regularly restricted bed availability.
A silver lining is that through higher pay and efforts to improve workplace culture by offering child care or flexible schedules, for example, hospital clinical staff turnover shrunk by 19% one year after having shrunk 28%.
“Despite the remarkable progress that Pennsylvania’s hospitals and health systems have made reducing turnover, growing their teams, and transforming care delivery, the commonwealth continues to face a persistent shortage of health care professionals,” HAP President & CEO Nicole Stallings said. “These shortages are already affecting communities’ access to hospital and nursing home care and, without proactive action, challenges will only worsen as the commonwealth ages. It’s imperative that state and national leaders focus on policies that grow the number of health care professionals and ensure providers have the flexibility to innovate and meet their communities’ needs.”
Completed in tandem with LeadingAge PA and the Pennsylvania Health Care Association, long-term care facilities are similarly challenged — more than 5 in 10 limited admissions or cut back on occupancy capacity, almost 4 in 10 are deferring renovations and updates, and roughly 2 in 10 are operating with wait lists, reduced non-clinical services or programming or even shuttered entire wings or units.
More than half of nursing homes reported having at least 11 staff vacancies.
The workforce survey includes 330 respondents who manage hospitals, nursing facilities or adjacent services for senior citizens. It was conducted Nov. 11, 2024, to Jan. 15, 2025. The 119 responses from hospitals represent approximately 65% of staffed beds, according to HAP.
“Because of the workforce crisis, our providers, they’re not only limiting access, they’re also telling us in this survey that many are having to rely on temp agency staff,” said Garry Pezzano, president and CEO of LeadingAge PA.
The survey shows 70% of nursing home respondents contract with agency nurses with 57% increasing use while citing state regulations mandating a minimum level of direct care, 3.2 hours per patient. Agency nurses fill holes in nursing homes and hospitals where staff vacancies linger. They’re generally paid elevated rates and particularly benefitted when shortages became more pronounced at the height of the pandemic.
“That comes at a great cost. Now you have a reduced census, you’re paying more for labor and you’re really having to figure out how it is you’re going to afford all this. Unfortunately, in some instances, it is programming that is going to suffer. You’re not going to be able to run a memory care unit, invest in capital improvements, keep up with physical plant maintenance. It’s a vicious cycle,” Pezzano said.
Matt Yarnell is president of SEIU Healthcare Pennsylvania, the labor union representing about 7,000 workers in 117 nursing homes. He stressed that the staffing regulations approved during the administration of former Gov. Tom Wolf are designed to improve patient care.
The regulations came at a time when it wasn’t unusual for certified nursing assistants and licensed practical nurses to care for 20 residents each shift, which he called “insane.” The limit is now 1 CNA for up to 10 patients on dayshift, 11 patients on evenings and 15 on nights. Yarnell described the ratio as a compromise, one he said should be more stringent and one too often used as an excuse by facility operators.
“You can’t just put your finger on the ratio and blame the ratio. What are the jobs and working conditions like in these facilities?” Yarnell said of the continued use of agency nurses. “If it takes paying agency wages to get people to do the work then I think we need to reevaluate what we need to pay to get people to do the work.”
Cinette Washington, a member of SEIU Healthcare PA, works as a CNA at a Philadelphia nursing home. She began 15 years ago when, she said, the entry pay was minimum wage: $7.25 an hour.
Washington spoke of the physically intensive bedside care she provides — getting residents out of bed, washing and dressing them, helping them eat, checking their vitals and preparing them for physical therapy, for example.
“They are not just patients, they become loved ones,” she said.
Washington said she finds herself at the busiest times and when staffing is low, caring for up to 14 residents with many needing full assistance. It directly affects not just how much time she can spend with each resident but how well they’re cared for, she said.
That means some patients are waiting to be fed, others are waiting to be washed, while Washington calls for help to lift a patient out of bed.
She said concerns raised with management often go unaddressed. It adds to a feeling of burnout she’s experiencing, a feeling that’s driven colleagues to find work in other facilities or other career paths altogether.
“I don’t have time to even properly give them the care they need. I can’t even wash them properly,” Washington said of the busiest days. “I have to prioritize who is more important and that should never be in the health care field.”
Tammy May is a registered nurse of 32 years at Butler Memorial Hospital and is president of the hospital’s union chapter of the Pennsylvania Association of Staff Nurses and Allied Professionals.
She was in the picket line this week at Indiana Regional Medical Center where nursing staff have worked without a contract for about seven years. Though Pennsylvania has staffing ratios in place for nursing homes, ratios haven’t been approved for hospitals. The state House had adopted legislation last session but it went nowhere in the Senate.
May said a ratio is needed to better ensure patient safety.
“If you’re not staffed appropriately you miss those little nuances of change you see in a patient that if you miss could elevate as a problem,” May said, adding that situations where hospitals are understaffed endangers patients and pushes nurses to breaking points where they feel their license might be in jeopardy.
“Me having a better ratio isn’t about me, it’s about me taking care of that patient in that bed. That’s what’s driving nurses away from the bedside, that they’ve been functioning under unreasonable terms for so long,” May said