“Although less than half of 1 percent of the U.S. population resides in nursing homes, they account for nearly 40 percent of all Covid deaths. Nursing homes are supposed to help residents remain safe and healthy, but the opposite turned out to be the case: When it came to the coronavirus, residents in nursing homes were more vulnerable, not less.”
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“rebuilding nursing home facilities is an expensive and long-term solution to an immediate crisis. I’ve been studying long-term care settings for many years, and I think there’s a quicker and possibly even more effective approach we can take in the short term to ensure better care for our seniors in the post-Covid era: improve staffing.
It’s no secret that nursing home staff are paid relatively poorly for incredibly demanding work. Certified nurse aides who provide over 90 percent of direct resident care are often paid at or near minimum wage — the same wages as entry-level workers in retail establishments or fast-food chains. Nursing staff are also underpaid; registered nurses and licensed practical nurses who work in nursing homes are often paid below their counterparts who work in hospitals and other health care settings.
What’s more, nursing home staff often lack essential benefits, like health insurance and paid sick leave. That means nursing home workers are incentivized to come to work even when sick — how does that make sense when they are caring for medically vulnerable residents during a pandemic?
Nursing homes are also very hierarchical workplaces with lower-level staff having little autonomy and control in their jobs. Not surprisingly, being undervalued and unempowered makes it hard to recruit and retain individuals to work in nursing homes.
The result is that many facilities around the country often have dangerously low levels of staffing. Additionally, the average U.S. nursing home was recently found to have an annual staff turnover rate of 128 percent. This suggests an average facility’s staff completely changes over the course of a year, and many nursing homes have even higher turnover rates — as much as 300 percent — suggesting the staff changes every four months. If some part of good nursing home quality depends on the relationship between staff and residents, it’s hard to see how those relationships can develop when staff keep changing.”
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“There are a number of things we can do to improve this situation. Here are a few ideas”
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“One solution would be to increase the number of direct care workers by raising the federal minimum staffing standards in nursing homes. The federal standards are relatively low and have not been updated in over 30 years. Many states set staffing levels above the federal standards and these state policies have generally been found to increase staff.”
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“Another idea is to raise minimum wages to increase nursing home staff pay. Many certified nurse aides would see their hourly wages increase under the $15 minimum wage proposed by the Biden administration. In the absence of a broader minimum wage hike, policymakers could also increase wages specifically for nursing home and other long-term care workers.”
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“The elephant in the room is what additional Medicaid or other public funding would be necessary to pay for greater staffing and higher wages. The nursing home industry will inevitably push back against any “unfunded mandates.” The Medicare Payment Advisory Commission has found overall nursing home operating margins are currently thin based on the Medicare cost reports. However, there is quite a bit of variability in profitability across facilities. It is also unclear whether some facilities are accurately reporting their costs. Resident advocates have questioned whether a sufficient amount of existing public nursing home funds are spent on staffing. Thus, higher Medicaid funding will be necessary to improve staffing levels and wages, but it needs to be paired with the next suggestion.”
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“We currently lack transparency in how nursing homes spend public dollars on staffing and other areas. Nursing homes are required to submit Medicare cost reports each year to detail their revenues and spending, but these data are known to be incomplete, especially in the context of increasingly complicated corporate ownership arrangements. A series of financial reporting and oversight steps need to be taken to tighten the requirements for facilities. The bottom line is that regulators need to be able to follow the public’s money and ensure it is being spent on staffing as policymakers intended.”
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“Beyond putting more money into wages, policymakers might also consider ways in which they could provide financial support to allow additional education and training to certified nursing assistants and licensed practical nurses seeking upward mobility within a facility. For example, some nursing homes currently have ladder programs that provide nursing assistants with financial support in seeking nursing degrees. These programs could be expanded through direct reimbursement via Medicare and Medicaid.”
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“Improving wages and benefits is a necessary but insufficient step towards valuing nursing home caregivers; we also need to begin to value the work these individuals do and the individuals that do it. If you can believe it, this might be harder than increasing staffing standards and wages. Finding additional money is one thing — changing the culture around nursing home staffing is another.”
The New Americans: Economic, Demographic, and Fiscal Effects of Immigration National Research Council. 1997. The National Academies Press. https://www.nap.edu/read/5779/chapter/6#138 Yes, Immigration Hurts American Workers George J. Borjas. 9/10 2016. Politico. The Impact of IllegalImmigrationon the Wagesand EmploymentOpportunitiesof Black Workers The United States
“ProPublica interviewed 15 teenagers and young adults in Bensenville alone who said they work or have worked as minors inside more than two dozen factories, warehouses and food processing facilities in the Chicago suburbs, usually through temporary staffing agencies, and nearly all in situations where federal and state child labor laws would explicitly prohibit their employment.
Though most of the teens interviewed for this story are now 18, they agreed to speak on the condition that they not be fully identified and that their employers not be named because they feared losing their jobs, harming their immigration cases or facing criminal penalties.
Some began to work when they were just 13 or 14, packing the candy you find by the supermarket register, cutting the slabs of raw meat that end up in your freezer and baking, in industrial ovens, the pastries you eat with your coffee. Garcia, who is 18 now, was 15 when he got his first job at an automotive parts factory.”
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“The teenagers use fake IDs to get the jobs through temporary staffing agencies that recruit immigrants and, knowingly or not, accept the papers they are handed.”
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“Before they disappeared into crowded assembly lines, the young Guatemalan immigrants in Bensenville arrived in the United States as part of a new wave of young Central American asylum-seekers who have captured the nation’s attention in recent years.
Many of them passed through the federal network of shelters for unaccompanied immigrant minors that came under scrutiny in 2018 during the Trump administration’s policy of separating children from their parents. As they waited weeks or months to be released to sponsors, they grew anxious about their mounting immigration debts, desperate to get out and work so their relatives back home didn’t suffer the consequences of a loan default.
“Honestly, I think almost everyone in the system knows that most of the teens are coming to work and send money back home,” said Maria Woltjen, executive director and founder of the Young Center for Immigrant Children’s Rights, a national organization that advocates for immigrant children in court. “They want to help their parents.””
“because chickens and pigs (and cows and lambs and turkeys … ) are living things whose shapes and sizes vary, cutting and pulling breast meat from chickens, for example, can’t be done with machines or robots. It has to be done by human beings, and to achieve the output that slaughterhouses and meatpacking plants want, it has to be done quickly.
The plants’ practice of placing workers shoulder to shoulder, while doing exhausting work that leads to heavy breathing, has made them epicenters for the coronavirus outbreak this year. The Trump administration has tried to keep the mostly low-income workers in these plants working all the same out of fear of a “meat shortage,” putting the workers at considerable risk.
That’s hardly the only risk, however, that workers in these plants face. According to the Bureau of Labor Statistics, workers in animal slaughter and production face higher rates of injury than coal miners or construction workers. Poultry processing in particular is the leading occupational cause of finger amputations in the US.”
“The agency conducted slightly fewer safety inspections during the first three years of Trump’s presidency than during a comparable period at the end of President Barack Obama’s second term, even though the labor force grew by 16 percent, according to a Center for Public Integrity analysis of the agency’s inspection data.”
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“The slowdown in inspections could prove dangerous for millions of workers: A Public Integrity analysis shows the vast majority of deaths and catastrophes have occurred at workplaces that weren’t inspected by OSHA.”
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“The lax scrutiny comes as Trump continues to trim the regulatory powers of federal agencies. Under his watch, the Labor Department has systematically weakened rules meant to protect workers’ pay, retirement, and safety. The department, for example, scaled back a rule to extend overtime pay for millions of workers. It also tried to change pay rules to let employers pocket workers’ tips — a move later undone by Congress.
The department also has been slow to hire and replace inspectors at OSHA; their number fell from 952 in 2016 to 862 in January, the lowest number of inspectors in the agency’s history, according to the National Employment Law Project.
Staffing has since gone down to 761 inspectors, according to the Labor Department.”
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“During the first three years under Trump, OSHA conducted about 81,000 safety inspections — a 4.7 percent decrease from about 85,000 conducted during the last three years of Obama’s presidency, according to a Public Integrity analysis of the agency’s inspection data.
“Unless someone dies at a workplace or there’s some significant accident, [the employer] is very unlikely to be inspected now,” said a former OSHA official under Obama, who spoke on the condition of anonymity because he is not authorized to speak to the press at his new job.
But Congress hasn’t cut OSHA’s enforcement budget; instead, it has given the agency slightly more funding than the administration has asked for. It earmarked $576.8 million for fiscal year 2020 — $19.3 million more than requested.
Former OSHA officials say the decrease in inspectors has more to do with the federal hiring freeze imposed during Trump’s first year in the office. Dozens of inspectors left their jobs in the months following his inauguration, and the Labor Department has been slow to replace them.
OSHA “has done a poor job filling the vacancies,” said Rebecca Reindel, safety and health director for the AFL-CIO labor federation.”
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“Research shows that OSHA inspections have a significant impact on safety. In 2012, for example, researchers at Harvard University and the University of California Berkeley found that companies subject to the agency’s random inspections showed a 9.4 percent decrease in injury rates compared with uninspected ones. They also found no evidence of any added cost to inspected companies from complying with regulations.
In 2010, researchers with the RAND Corporation analyzed workers’ compensation data in Pennsylvania and found that OSHA inspections were linked to a sharp decline in reported injuries at medium-size companies. Inspections that led to citations with penalties played a role in reducing injuries by an average of 19 to 24 percent each year for the two years following each inspection.
“Inspections work,” said Reindel of the AFL-CIO. “If an employer thinks they won’t get inspected, they will take fewer steps to protect workers.””
“Because paid leave is costly, when firms provide this benefit, they change the composition of their employees’ total compensation by reducing the value of workers’ take-home pay to offset the cost of providing paid leave. While some workers prefer this mix in their pay packages, others don’t. In particular, mandated leave would be a hard trade-off for many lower-paid women who would prefer as much of their income as possible in the form of take-home pay.
In fact, polls show that when women learn of the trade-offs inherent in any government-mandated paid-leave policy, their support for such a policy collapses.”
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“A well-cited NBER paper looks at Denmark’s very generous paid leave policy and finds that before having children, women’s hours, employment, and wages are equal to those of men, but that these metrics all worsen relative to men after having children. Another recent NBER paper expands on this research and shows that while this divergence also exists in the United States, it’s significantly smaller here.”