RALEIGH, N.C. (WNCN) — Nursing homes across the state continue to face staffing issues with nearly 30 percent of those responding to a government survey reporting critical employee shortages even as their occupancy rates dipped slightly, a CBS17.com data analysis found.

CBS17.com reviewed data Wednesday released by the Centers for Medicare and Medicaid Services for the week ending Sept. 20, the most recent figures available.

Those figures show 408 of the 427 nursing homes in the state responding to questions about staffing. Of those, 114 — or 28 percent — reported that they don’t have enough employees in one of four key areas: nursing staff, aides, clinical staff or other staff.

Those shortages have been a problem in the state since the 1980s, said Sandi Lane, an associate professor of health care management at Appalachian State University. They’ve only gotten worse since the start of the COVID-19 pandemic.

“It was already a critical shortage of direct care workers, especially certified nursing assistants, before COVID,” said Ted Goins, the president and CEO of Lutheran Services Carolina, which operates several facilities across the state. 

“And when COVID hit, it was like the tidal wave hitting on top of the tidal wave,” he added.

The data showed 25 percent of nursing homes were in need of aides, 20 percent had shortages of nurses, and 12 percent were short of other staff.

The breakdown of nursing homes experiencing shortages in four staffing categories, with 408 of the state’s 427 nursing homes responding to questions about staffing.

That’s despite a steady, if small, decline in the occupancy rates of those facilities, with the most recent figures showing 72 percent of total beds were occupied compared to nearly 76 percent in late May, when CMS began releasing that data.

Dr. Tim Carey of the University of North Carolina pointed to several anecdotal reasons for that drop, from the pandemic leading people to postpone elective surgeries that would have led to stays in nursing homes, to patients now being treated at home by family members instead of those facilities after leaving hospitals.

“That’s going to affect the bottom line of nursing homes,” Carey said.

A study published this summer in the Journal of the American Geriatrics Society found that nursing homes with higher staffing levels of registered nurses have a better chance to control the spread of COVID-19 and reduce deaths.

In North Carolina, nursing homes account for 12,583 of the more than 222,000 total cases but 1,507 of the 3,693 deaths — or more than 40 percent. Of the 213 homes experiencing active outbreaks according to Department of Health and Human Services data released Tuesday, 57 of them — or 27 percent — are dealing with a staff shortage of some kind.

Both Lane and Goins say solving the problem of those staff shortages isn’t quite as simple as simply hiring more people.

“One of the problems — it’s all about the money, sadly, but it often is,” Goins said.

Both identified the low rate of government reimbursement for Medicare and Medicaid as part of the problem. Lane says that’s led to a pay rate of $11.74 per hour in the state. That, along with a lack of recognition, led to dissatisfaction with the job and contributed to the high level of turnover.

“Pay is huge,” Lane said, referring to a survey of nursing assistants from the spring. “They were the least satisfied with their pay rate, and the recognition they receive in their buildings. Those were the two biggest factors.”

Immigration reform also played a role because one in four nursing assistants is an immigrant, Goins said.

“And yet we’ve shut our doors to most immigration,” he said. “And especially entry-level worker immigration. So that has really slammed shut the pipeline of people that would be working all over the country and certainly in North Carolina in our facilities.”

Lane said a career ladder that leads to chances for advancement — and increased pay — would help with retention rates.

“If we bring in an untrained or a minimally trained worker, we provide them with skill-development access to various certifications or credentials,” she said. “And with that knowledge level would be that renumeration so that they can live above the poverty level, give them some financial stability.

“We’ve got to elevate the position,” she added. “More training, more recognition, even at the nursing level. The research is showing that … we need to have more (registered nurses), stronger (licensed practical nurses) and knowledge other than just clinical knowledge. Leadership, professionalism, relationship-building.”