About a third of facilities across the state report a shortage of nurses and aides, according to federal data.
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"I will tell you that right now, the highest percentage of nursing homes in North Carolina who are reporting a shortage of workforce is the highest has been at any point in the pandemic," said Adam Sholar, the president and CEO of the NC Health Care Facilities Association.
Nursing homes in Wake, Durham, and Cumberland County are faring slightly better with fewer than 20% of facilities reporting a shortage of nurses and aides.
The North Carolina Health Care Facilities Association found that the pandemic and low wages were the top reasons employees cited for leaving the field. A survey that the association completed during the summer estimated the workforce has declined by 12.5% since January 2020 as more than 15,000 employees have left facilities.
"We continue to see month over month employees leaving this workforce largely citing reasons related to COVID or overall burnout and the path that we're on is not sustainable," Sholar said. "This, this is a workforce crisis."
Though nursing homes were experiencing shortages before the pandemic, the ongoing decrease is concerning to Sholar and others.
The shortages are causing some facilities to stop accepting new residents. Sholar said in the fall around 60% of facilities across the state reported restricting admissions.
"There are countless North Carolinians today who need nursing home care but aren't in a nursing home and they can't go to a nursing home because there aren't enough staff members to provide care for them there," he said.
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Nancy Ruffner, a patient advocate and founder of Navigate NC, helps connect families to senior care throughout the Triangle. She said the pandemic paired with a shortage of home aides and nursing home staff has taken a toll on families.
She said it is more difficult to search for the best care options for families now as families need to navigate capacity limits but also evaluate health risks connected to each option. Ruffner does worry about the long-term impact of continual workforce shortages.
"I'm concerned, very concerned, for my clients that they have options," she said.
Some fear the looming federal vaccination mandate will further reduce the workforce. Around 21% of nursing home employees in North Carolina remain unvaccinated, according to the latest federal data. The mandate was originally supposed to go into effect this week but various legal actions have delayed it.
Vaccination rates in the Triangle for workers are higher than the state average with 91% of staff in Wake County reportedly fully vaccinated and 90% in Durham County.
A survey done during the summer by the NC Health Care Facilities Association found that 50% of unvaccinated employees said they would resign if a mandate was enforced.
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The health of residents inside nursing homes also remains a concern. This week, the North Carolina Department of Health and Human Services reported nearly 250 ongoing outbreaks in nursing homes across the state. Statewide 13% of nursing home residents are unvaccinated.
Both Ruffner and Sholar said the biggest issue is wages, something that will require better funding from the government.
"Until government payers pay adequate rates to nursing facilities, they can't then turn around and provide higher wages for their employees," Sholar said.
The NC Health Care Facilities Association is also working with community colleges across the state to train nurse aides. The association received a federal grant and aims to train 4,000 aides in the coming years.
However, these shortages won't be fixed overnight or without ongoing attention.
"I am fearful. I am fearful of this," Ruffner said. "There are already millions of unpaid caregivers, people giving another 20 hours a week after their conventional job in-home care to their loved ones. And we're only hastening their breaking point. So I'm not sure what the answer is and I know that moving toward a solution is education, having conversations like this."