AUSTIN (NEXSTAR) — Long-term care facilities are still facing a staffing crisis amidst this holiday season, and likely will continue for months to come.

A report from Texas Health and Human Services shows since 2022, at least 60 nursing facilities in the state — 2% — have permanently closed. The effects of the pandemic, inflation, staff burnout, and low Medicaid reimbursement rates are among the reasons facilities have had to close their doors.

“I would say easily, the staffing and the workforce crisis that we’re dealing with… is easily the most significant challenge that I’ve seen. Since I’ve been involved in this profession,” Kevin Warren, president and CEO of Texas Healthcare Association, said.

The staffing crisis has affected many communities across Texas, with rural communities specifically facing much of the blow. Two-thirds of the permanent closures since 2018 happened in rural areas.

Warren said the low staffing, combined with closing facilities, can lead to dire situations. He used the example of when an elderly Texan is discharged from the hospital and needs 24/7 care, but the local facility that they normally refer to has no staff to take another resident.

At best, he said families experience longer waits for a bed or drive 20-30 miles for care in another community. But for Texans in areas without facilities, it can mean some are stuck without the care they need to get through their last years with dignity.

“People are living longer and staying at home longer. By the time they get to long-term care facilities, they’re sicker. They require a higher level of care,” Warren said. “And so we have to make sure that we’ve got enough staff — with the training, with the skill set — to be able to care for them.”

Bryan Bankhead is the administrative director at Focused Care at Stonebriar, a long-term care facility in Austin. Even in a metropolitan city, he also has several important staff vacancies that he’s having trouble filling. The understaffed facility, however, is a problem he says existed long before the COVID-19 pandemic.

“We’ve always had trouble with staff, even before the pandemic, just now it’s harder to obtain the staff, because they’re just not there,” he said. “We’re able to get it staffed. But again, people are picking up extra shifts.” 

As a way to prevent burnout, his facility offers flex scheduling to help ensure nurses have a better work-life balance. 

But still, Warren said having an understaffed nursing home can lead to a host of problems when employees are working overtime and double shifts just to keep the facility running.

“They want to make sure that they’re not tired and they don’t make mistakes, simply because they’re trying to do everything…it’s so important that we find ways and find solutions to bring more staff into the facility” Warren said. 

Other short-term solutions many facilities are forced to rely on include temporary travel nurses. But Warren said hiring traveling nurses can disrupt the continuity of care for patients with diseases like Alzheimer’s who often need consistency for stabilization; not to mention create rifts with permanent staff, as agencies pay travel nurses at least 50% more per hour than for full-time staff.

The Texas Demographic Center predicts Texas’ aging population — those 65 and older — will reach nearly 6 million by the year 2030, which is a 115% change from its elderly population in 2010. It’s just one reason why advocates say, these ongoing staffing shortages need to be addressed so that Texans will be able to get the care they need as they age.

Warren and Bankhead said the big picture solutions start with addressing funding long-term care facilities receive, specifically Medicaid reimbursement rates in Texas.

“What we really need is better reimbursement for our nurses and staff all around. It’s not just a nurse shortage. It’s a staffing shortage with all physicians. We need better reimbursements to be able to compensate them and make the field more attractive,” Bankhead said. “It has to come from the state.”

As for tackling long-term solutions, Warren said addressing the workforce shortages will need to start from the ground up. He wants to see legislation that creates more opportunities with nursing schools and practicing nurses to incentivize them to work at long-term care facilities.

“We’ve been working with lawmakers on this. They’ve been trying to help us along the way with other inroads. We’ve got to have long-term, predictable, and increased reimbursement rates to address… the long-term workforce shortage.”