\n\n“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\u2019ve been studying long-term care settings for many years, and I think there\u2019s 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.
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It\u2019s 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 \u2014 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\u2019s 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 \u2014 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\u00a0dangerously low<\/a>\u00a0levels of staffing. Additionally, the average U.S. nursing home was recently found to have an\u00a0annual staff turnover rate of 128 percent<\/a>. This suggests an average facility\u2019s staff completely changes over the course of a year, and many nursing homes have even higher turnover rates \u2014 as much as 300 percent \u2014 suggesting the staff changes every four months. If some part of good nursing home quality depends on the relationship between staff and residents, it\u2019s 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\u00a0federal standards<\/a>\u00a0are relatively low and have not been updated in over 30 years. Many states set staffing levels above the federal standards and\u00a0these state policies<\/a>\u00a0have 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\u00a0increase wages<\/a>\u00a0specifically 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 \u201cunfunded mandates<\/a>.\u201d The Medicare Payment Advisory Commission has found\u00a0overall nursing home operating margins are currently thin<\/a>\u00a0based 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\u00a0advocates have questioned<\/a>\u00a0whether a sufficient amount of existing public nursing home\u00a0funds are spent on staffing<\/a>. 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\u00a0lack transparency in how nursing homes spend<\/a>\u00a0public 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\u00a0financial reporting and oversight steps<\/a>\u00a0need to be taken to tighten the requirements for facilities. The bottom line is that regulators need to be able to follow the public\u2019s 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 \u2014 changing the culture around nursing home staffing is another.”<\/p>\n\n\n\n