AUSTIN (KXAN) — While COVID-19 cases climb in Texas nursing homes, another crisis is plaguing these facilities: staffing shortages.

Industry leaders estimate a 15% reduction in the skilled nursing workforce during the pandemic. Kevin Warren, the president and CEO of the Texas Health Care Association, said they are concerned the industry could face more of a strain due to the surge of the omicron variant.

“This is becoming the roller coaster we can’t get off,” he said. “We have to stay on it because the residents and the families are counting on these providers to protect the health and safety of the residents. It has been it has been a challenge.”

Figures from the U.S. Bureau of Labor Statistics show 3,371,800 workers in Nursing and Residential Care Facilities in March 2020. By May, that number had dropped to 3,192,400. Preliminary numbers from December 2021 show a workforce of 2,958,700.

Leaders at the national nursing home advocacy group American Health Care Association pointed out that the skilled nursing industry had been hit harder by labor shortages than other health care sectors.

“What it’s causing is — the staff that are still there — it’s longer shifts, it’s more doubles, it’s more days without time off. It’s also further driving up the cost because the cost of bringing on travel nurses or traveling staff or staffing agencies is significant, compared to what they typically pay. So, all of these things are having a compounding effect,” he said. “It is easily the number one cost driver within the within the provider setting.”

That’s why his association and leaders at AHCA were urging public health officials to extend the Public Health Emergency, and the Health and Human Services Department eventually renewed it, as of January 16.

Warren said the extension was “crucial” to allow the facilities continued access to financial resources and other public health protections. For example, he pointed out the “temporary add-on,” which gives homes an extra $19.63 per resident, per day to cover increased costs associated with the pandemic.

KXAN asked Warren whether Texas facilities had used these payments or other programs to incentivize staff to stay. He didn’t know how many facilities had taken these steps, but said he had heard of everything from base salary increases to “hero” or hazard pay as bonuses.

Lori Porter, co-founder and CEO of the National Association of Health Care Assistants, said she was excited to see the base pay slowly rising for certified nurse assistants (CNAs). However, “what happens in one doesn’t necessarily have to happen in another,” she said.

She advocates for CNAs, after working as one for years.

“You are the first line of information, the first line of care,” she said. “You often feel like you are the most important in the room, but are rarely seen as that.”

She said, in addition to better compensation, the industry should focus on more education and support in order to not only fill open positions but to keep workers long-term.

She estimates a minimum of 12,000 CNAs are needed in Texas to fill the current shortages.

This week, her association launched NICE, the National Institute of CNA Excellence. The free, online training program will connect interested students with facilities for their clinical work and after graduation, as well as a mentor to support them during their first years on the job.

Porter launched NICE in Texas this week, before expanding it nationwide. She said 100 facilities across the state had already signed up to partner with them.

“Not just pair them, prepare them,” she said. “Preparing CNAs for skilled nursing? It is different. Taking care of elders and those living in long term care is different than working in the hospital. It’s different than home health, and we have to prepare.”