Providing enough assisted living units to accommodate a rapidly aging population is just one of the challenges facing Wisconsin. Staffing for those units is another.
A new report from Forward Analytics, the research arm of the Wisconsin Counties Association, examines how the increase in older adults in the state will affect its senior living and care infrastructure over the next 17 years. Nursing homes are included in the assessment as well.
LeadingAge Wisconsin President and CEO Lisa M. Davidson told McKnight’s Senior Living the report highlights the ongoing need to build capacity so operators can continue to provide the highest quality of life for residents.
The Wisconsin Assisted Living Association told McKnight’s Senior Living that it agreed with the premise of the report that more investments are needed in the state’s long-term care system to help alleviate the workforce crisis, allowing assisted living facilities to provide quality care to a growing resident population.
“WALA President and CEO Michael S. Pochowski said the Wisconsin Department of Health Services, the state legislature and the administration have helped to address the workforce crisis, including the Direct Care Workforce Funding Initiative, which provides funding directly to caregivers, and the implementation of a Family Care minimum fee schedule, which increased caregivers wages.
“These investments were badly needed, and we are hoping it will be fully funded in the upcoming state biennial budget,” Pochowski said.
The authors noted two important trends in long-term care in the state between 2000 and 2020. The number of both assisted living units and skilled nursing facility beds kept pace with the 75-and-older population during that time period, but the types of services shifted. The number of assisted living beds more than tripled from 2000 to 2023, whereas skilled nursing has declined “significantly.”
Since 2000, the number of beds in assisted living communities more than doubled, from 23,600 in 2000 to 50,800 in 2020. At the same time, however, the number of skilled nursing beds declined significantly, from 43,500 in 2000 to 28,000 in 2020. And in 2023, the number of nursing home beds continued to drop to 26,000, whereas the number of assisted living beds topped 80,000.
The report authors attributed the shift in care beds to Medicaid reimbursement for nursing home residents not keeping pace with the actual cost of care, as well as the state’s expansion of its Family Care program. From 2011 to 2020, Family Care funding for residential facilities doubled, growing from $455 million to $908 million, allowing many of the state’s older adults to live in assisted living communities.
If the trends highlighted in the report continue, Wisconsin would need to increase its total number of assisted living and skilled nursing beds by 138,000 by 2040, a 75% increase over the number of beds available in 2023, according to the report.
‘We know that the senior population is going to explode over the next 20 years,” the report stated. “We need to start planning now for how we are going to serve those in need.”
Workforce challenges
One of the most significant barriers to meeting those estimates for additional long-term care beds is the workforce necessary to serve such a large increase in residents.
If care ratios remain unchanged, assisted living communities and nursing homes would need an additional 9,900 registered nurses, certified nursing assistants and home health/personal care aides by 2030 to care for residents, according to the report.
The authors noted that assisted living communities and nursing homes are competing with other sectors for direct care workers. Although the number of RNs in Wisconsin increased from 56,700 in 2013 to just under 62,000 in 2023, and the number of aides rose from 54,800 to almost 75,000, the number of CNAs declined from 37,000 to just under 26,000 in 2023.
CNAs typically make up the majority of the assisted living nursing workforce, nationally accounting for 66% of nursing staff, compared with 19% for licensed vocational / licensed practical nurses and 15% for RNs as of January 2023, according to the National Center for Assisted Living.
Davidson said that increasing wages alone will not solve workforce challenges.
“We need to elevate careers in long-term care through educational partnerships, dedicated media campaigns and thoughtfully examining how we can improve the policy and regulatory environment for providers in Wisconsin,” she said.
Davidson pointed to the work of LeadingAge Wisconsin members with refugee resettlement agencies to help pair workers with communities. The initiative has proven successful and is now being highlighted at a conference of the Ontario Long Term Care Association, an affiliate of the Global Ageing Network, later this month in Toronto, she said.
“The sheer magnitude of the number of Wisconsinites who will pass the age of 75 should concern state and local leaders, particularly when every region and sector in the state is experiencing workforce shortages,” the report authors concluded. “Even if the public and private sectors were able to license enough beds in nursing homes and assisted living facilities to keep up with the aging population, there are not enough workers, specifically home health and personal care aides to provide needed care.”