Nursing homes have yet to rebound from the job losses they’ve suffered since the onset of the COVID-19 pandemic. Even as other healthcare sectors report gains, nursing home employment has largely been in a downward spiral. Despite adding about 2,100 jobs in January , nursing home employment is still nearly 5% lower than a year agoaccording to the most recent US Bureau of Labor Statistics jobs report.

A new study published Friday in JAMA shows that nursing home workers have received the greatest wage increases among any healthcare sector during the pandemic. Wages rose 6.3% in 2021 and 9.5% in 2020, compared to 2019, the study found.

David Grabowski, a professor of healthcare policy at Harvard Medical School, attributed this increase to nursing homes’ efforts to attract and retain workers. As an industry that has long operated under slim margins, nursing homes were able to raise wages through relief funds from the federal government, as well as hero and hazard pay funds offered by state governments.

“A key question is whether wages increased enough to offset the huge decline in workers,” Grabowski said. “It is interesting that—among healthcare employers—nursing homes exhibited both the largest wage increases during the pandemic, but also the largest decline in workers . This suggests wages were adjusted, but perhaps not enough to offset the huge loss in workers.”

Throughout the pandemic, nursing homes have had to turn to higher-paid agency staff to cover staffing shortfalls as they’ve competed with other healthcare and non-healthcare sectors for workers, he said. Operators have struggled to fill the challenging low-wage positions for yearsand now are competing with fast food and retail roles that offer higher wages and more benefits.

AHCA/NCAL said long-term care providers are doing everything they can to keep workers, including offering hero pay, wage increases and bonuses.

“Yet, despite these investments in our staff, long-term care is still facing a historic workforce crisis. Now, providers are paying exorbitant rates to temporary staffing agencies, and, with fixed government reimbursement rates, it’s unsustainable,” AHCA/NCAL said in an emailed statement. “It is evident that we need a more comprehensive solution to address the workforce challenges in long-term care.”