Jennifer Ungru: Unaddressed health care staffing shortages could lead to worker crisis

health care workers 12.14.21
There's no silver bullet, but there are things policymakers can do.

Almost every industry is facing a current workforce shortage. But unlike restaurants and retail, most health care entities need to be 24/7, 365 days a year.

These front-line workers who are responding to emergencies, walking the halls of the hospitals, and providing daily care for those who need it, are experiencing a compounded crisis exacerbated by high burnout rates in a highly skilled and regulated field that cannot replace workers at the same pace at which we’re seeing them leave.

The population explosion in Florida has 21.4 million people calling the Sunshine State home, more than 4.5 million of them being over the age of 65. Soon the state will not be able to handle the health care needs of our residents.

Dwindling ranks of nursing professionals and home care aides to care for those aging Baby Boomers, even as inadequate numbers of younger individuals seek to enter the nursing profession, are adding to the current crisis. And to make matters worse, caregivers are leaving the profession due to burnout and stress brought on by the pandemic.

A new report commissioned by the Florida Hospital Association and the Safety Net Hospital Alliance of Florida reflects a 25% turnover rate for Florida nurses overall, with even higher turnover rates of 35% for licensed practical nurses and certified nursing assistants (CNA). The shortages are not just impacting providers in facilities, it’s impacting our overall ability to deliver health care services in Florida.

Staffing shortages have led to home health and home care agencies turning patients away and developing waiting lists. Nationally, 800,000 individuals are on waiting lists for home- and community-based services.

In October, the Home Care Association of America surveyed its 4,000-member agencies to confirm this trend. Preliminary results show:

— 66% have anywhere from 10 to 40 home care aide vacancies

— 42% have turned away a range of 11-20 cases each month; 12% have turned away 21-40 cases a month because they don’t have enough staff to cover caseloads.

— 95% indicated that they have increased starting wages in the past year. Of that, 64% have raised wages by $1 or more an hour.

Last week, the Florida Legislature convened the final interim committee week in preparation for the 2022 Legislative Session. Throughout the week’s meetings, both the House and Senate heard from providers on how the staffing shortages are leading to access to care issues and worsening health outcomes. The Senate Health Appropriations Committee discussed chronic Medicaid underfunding for various providers and its compounding impact on staffing vacancies.

While there is no one silver bullet that can attack this crisis, there are adaptations that policymakers can and should consider in light of the challenges and impact the last two years has imposed on our health care workforce.

Increased Medicaid rates, especially for those provider types at the low end of the spectrum, would address immediate needs; however, fixes to the education and regulatory framework would ease systematic issues.

The Legislature has passed a few measures to help, and are considering additional ideas to lessen the burden and put Florida’s health care workforce on the path to recovery and even growth. A comprehensive look could include:

— Medicaid rate increases to ensure providers can meet the minimum wage standards and compete for qualified staff.

— Continuing and broadening grants to pay for training courses for nurses, CNAs and home health aides.

— Allowing and attracting trained medical staff to teach will grow the capacity for the training programs.

— Review of current licensure process for individuals and entities to see if requirements meet the current and emerging health care practices.

Ensuring we have the health care workforce to care for our residents will safeguard Florida as THE place where people want to live, work and play.


Jennifer Ungru served as chief of staff for the Agency for Health Care Administration (AHCA) from 2012 to 2015. The agency oversees the state of Florida’s Medicaid program and regulates more than 45,000 health care facilities. During her tenure, the agency implemented major health reforms, including the movement to Statewide Medicaid Managed Care.

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One comment

  • Fred Boesch

    December 14, 2021 at 11:28 pm

    These reports and studies appear to give such little information that one cannot construct a logical definition of the problem. The number and types of employees in each recent year, and if declining or not sufficiently increasing what reasons have been determined by study and weight? What have the requirements been by year and the causes and weights of each? What does data analysis suggest for applicable models actions do the models suggest? What studies have been conducted to determine technology, situational and corporate/contract changes the can reduce the requirements? What are the economic action changes after the other requisite changes are implemented?. It seems like people and politicians want to address a problem with little information that will lead to poorly defined and some incorrect actions and results.

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