65% of Nursing Homes Report Poor Health Outcomes From Staff Shortages—Internal Hiring Could Be the Key to Retaining Talent

By: Lisa Morris on July 19, 2022

You’re no doubt already aware that, among an overwhelming number of crises already facing the U.S., we’re still facing a huge shortage of qualified healthcare workers. If you work for a practice that provides elderly, long-term, or palliative care, you’re probably also aware that these specialties are among the hardest-hit by this staffing shortage.

In an effort to better understand what’s causing the problem and how nursing homes can mitigate it, Software Advice surveyed nurses, physicians, owners, and administrators currently working in nursing homes, geriatric practices, palliative care providers, and assisted living facilities[*]. We asked them about the current issues their employees are facing, as well as strategies they’ve adopted to find and support qualified employees.

Key findings:

  • Staff turnover is high: 50% of respondents said they lost between one and 10 employees in the past year. And the top reason employees gave for quitting was being overwhelmed by the workload.

  • 65% of employees at elderly care facilities have witnessed a negative health consequence for a patient in the past two years caused by staffing shortages; 52% of them saw this happen on more than one occasion.

  • On average, facilities that use internal recruiting methods had 22% less turnover in the past year than those using external recruitment resources.

Elderly care providers hit hard by staff shortages

In our survey, we asked respondents how many staff members voluntarily left their jobs in the past 12 months, and found that turnover rates are incredibly high.


Half of respondents say they lost between one and 10 employees, and a fifth have had between 11 and 20 employees quit in the past year.

This isn’t terribly surprising, unfortunately. The rate of burnout among all healthcare providers has been steadily increasing, and it saw a massive spike during the darkest days of the pandemic in 2020 and 2021.

We also asked our survey participants what reasons their employees gave for quitting, and found an overwhelming workload to be the top issue.


Inadequate pay is a close second, and over half cite a lack of support from management. There’s a lot of overlap here between the top stressors found in our healthcare employee retention survey published earlier this year, but a quarter of elderly care providers are suffering from the additional emotional toll of working with patients at the end of their lives.

Staff shortages are hurting patients

Elderly care specialties are treating patients at a frightening and difficult time in their lives, which makes the impact of staff shortages on patients all the more alarming.

What are the consequences of nursing home staff shortages, according to our survey? Decreasing quality of care and increasing response times to patient calls.

On average, it takes most nursing home staff between 11 and 20 minutes to respond to these calls, but 14% of providers said they usually take over half an hour.



That means the majority of residents in beds at these long-term care facilities are left waiting for care for up to 20 minutes. In that time, a lot of bad things can happen—something 65% of employees at these facilities confirmed.


A majority of staff at nursing homes and elderly care facilities have witnessed a negative health consequence for a patient due to reduced staff, and 52% of respondents observed a negative consequence more than once. Consequences include things like medication errors and missed diagnoses, which have the potential to cause irrevocable harm to patients.

If the staffing crisis continues without resolution, 78% of respondents said the biggest issue will be continued deterioration of the quality of care they are able to provide.

Nearly 60% of respondents say they would have no choice but to turn patients away, leaving elderly and palliative patients with fewer care options.


Some hope: Leaning on the right hiring techniques can help

We’ve covered a lot of bad news for nursing facilities so far, but there is some good news to be had. Certain strategies are proving effective to mitigate turnover and reduce mistakes for these types of practices.

It starts with how you hire your employees. We asked respondents what method they use to post jobs and seek new hires.


Public job posting sites like ZipRecruiter and Indeed are the most common, but not the most effective.

When we compared responses to this question with responses to our turnover rate question, we found that practices using internal recruiting methods (in-house recruiters and referrals from existing employees) have a significantly lower rate of turnover than those using external methods such as public job postings and third-party staffing agencies.


This tells us that practices are more likely to hire new employees who are better prepared for the job if they rely on in-house recruiters and referrals from current employees who are already familiar with the practice to find them.

The next consideration is how best to support qualified staff once you hire them, and the answer is: with software and technology.

Supporting your staff is the next step to retaining them

Our survey found that 46% of nursing homes are currently using a human resources (HR) software system to manage their employee experience.


HR software systems contain a multitude of module options built to improve the employee experience, including tools for employee feedback, benefits access and management, payroll preferences, employee scheduling, performance management, and more.

The fact that not even half of facilities are actively using this software tells us that the employee experience is not being considered as heavily as it should for retention. Keeping qualified employees starts with making sure they have what they need to perform their jobs.

Which leads to our next technology finding: We asked how many respondents are currently using a robotic processing automation (RPA) system at their facilities. RPA platforms are a type of business processing automation tool that allows users to define a set of instructions that a bot can then perform.

We found that only six percent of facilities use this type of software.


Using an RPA allows bots to handle tasks such as data entry and shift filling, taking these tasks out of the hands of employees and freeing them up to handle more important responsibilities.

We also found that the number of employees who witnessed negative health consequences caused by staffing shortages was somewhat reduced among those who worked at practices that use RPA platforms. While the number of respondents in our survey who said they use RPA systems was too low to make a reliable connection, the trend did indicate the possibility of a reduced number of mistakes among facilities using this technology.

With all this in mind, we’ve come up with two key recommendations to help you minimize staff turnover and retain qualified employees, longer:

  1. Look to internal recruitment methods to hire more successful employees. Ask the people currently working for you to refer candidates, and hire an in-office recruiter who will have a firm understanding of what your facility needs in a new hire.

  2. Invest in software that will make your employees’ lives easier. HR software can better manage the employee experience, and technology designed to handle menial tasks and eliminate human error will make things run more smoothly.

Elderly care is a specialty that demands compassion and effort, so the people that choose this career deserve careful consideration and attention. Supporting them in all the ways they require is the best path forward and out of the current staffing crisis.

Survey methodology

* Software Advice’s 2022 Nursing Home Staffing Survey was conducted in May 2022 among 204 U.S. respondents. We used screening questions to narrow the respondents down to those currently working in elderly care facilities, including nursing homes, geriatric practices, palliative care and long-term care facilities. Respondents were limited to those occupying positions for at least 6 months that would give them access to knowledge required to answer our survey questions, including nursing staff, physicians, practice owners, and office administrators.