Workforce aid eyed to stabilize nursing homes
PHOTO | Courtesy of the Massachusetts Senior Care Association
The Massachusetts Senior Care Association said the state's nursing homes are at a "crisis point."
Senior care and health workforce advocates say increased pay for care workers included in a priority bill on Beacon Hill would help address the staffing shortages that have plagued the state's nursing homes in recent years and led to a decline in quality of care.
House Speaker Ron Mariano signaled in February that supporting long-term care was high on his priority list for the 2023-2024 session, after the COVID-19 pandemic thrust problems at nursing homes and similar facilities into public view, though he hasn't said exactly what that support will look like.
Increased Wages
The omnibus "nursing home bill" (H 648 / S 379) -- one of three bills before the Joint Committee on Elder Affairs at a hearing on Monday morning -- would increase pay for staff who work in nursing homes and long-term care facilities to a "living wage."
Advocates argue that low wages for high-responsibility jobs have caused many nurses to move on, especially as wages are rising in sectors such as retail and food service. Others have moved to temporary or travel nursing agencies where they can make double or triple the amount they earn as a nursing home employee. This is harmful both for the workers and for patients in long-term care facilities who rely on a continuity of care, they say.
"The biggest impediment and barrier to folks entering this workforce is low pay." Tim Foley, executive director of health care worker union 1199 SEIU, told the committee on Monday. "We hear from our members that are working two to three jobs just to make ends meet in health care and nursing home care, it's just unacceptable. So the bill addresses that directly."
The Sen. Pat Jehlen and Rep. Thomas Stanley bill would require Medicaid rates to be increased for the nursing home industry to support "living wages" for their workers.
As more nurses and direct care workers leave the industry, worker shortages have left the sector "near capacity," according to a survey by the Massachusetts Senior Care Association. The the new survey found the statewide average operating occupancy rate of 93 percent and over 90 percent in every county in the state.
More than 3,000 licensed beds are unavailable due to staffing constraints, the association said, and there are currently 8,000 job vacancies across the system, or one in every five positions.
The situation means that most facility nurses are working overtime and facilities are racking up big costs for temporary nurses.
"We are acutely vulnerable to continued severe access challenges for consumers and hospital patients seeking short term or long-term placement in a skilled nursing facility," said MSCA President Tara Gregorio.
More than half of the state's nursing facilities have intermittently had to deny new admissions, the association said, and access problems could intensify over the next year as demand for care grows in combination with more facilities closing. The association said worker shortages contributed to the closure of 25 nursing facilities since the start of the pandemic in 2020, and said the pace of closures is "accelerating at an alarming rate in Massachusetts."
Increasing wages for nursing home and home health care workers was among the recommendations in a a recent report by the Health Policy Commission, which identified the workforce shortage as one of the most significant problems facing the industry.
Registered nurse vacancy rates in Massachusetts hospitals doubled from 6.4 percent in 2019 to 13.6 percent in 2022, with especially high vacancy rates in community hospitals, the HPC report says.
The HPC also recommended more career ladders for lower-paid care workers to get advanced nursing degrees while being supported by their employers -- a provision that Elder Affairs Committee co-chairs Jehlen and Stanley included in their legislation, and Gov. Maura Healey has also shown support for.
The nursing home bill would establish an extended care career ladder grant program for nurses' aides, home health aides, homemakers and other entry-level workers in long-term care, create a grant program for nursing facility supervisory and leadership training, and establish a tuition reimbursement program for certified nursing assistant training. This policy is similar to a proposal Healey put forward in a supplemental budget she filed earlier this month to create new career ladder incentives for licensed practical nurses.
The governor wrote in her supplemental budget filing letter that the $10 million program would "support nursing facilities and home- and community-based services providers in their efforts to retain direct care staff and upskill them to LPNs. The program would fund no-interest loans and grants to support the cost of attending an LPN certification program, as well as living expenses while attending."
"We know that there are a number of workers who want to become CNAs, but need access to the training opportunities to do that, but also to make sure that they can get paid while they're doing it," Foley said. "Workers can't afford to lose a day's pay."
Civil Penalties
Attorney General Andrea Campbell spoke to a provision included in the bill that will change the way her office is able to prosecute elder abuse.
The bill would increase civil penalties for nursing home workers or caregivers who commit abuse or neglect, leading to death, from $50,000 to $250,000. It would also expand penalties for other levels of harm -- allowing the AG to fine $25,000 for abuse or neglect if the individual is not injured, $50,000 if a senior is injured, and $100,000 for sexual assault or serious bodily injuries.
"If we want to really get accountability when there's wrongdoing, the penalty must be strengthened so that they reflect the severity of the offenses," Campbell told the committee.
The bill also increases the time in which the AG's office can bring a civil suit from two years to four years.
Campbell said her office has "repeatedly identified" nursing homes that are not offering quality care.
"One investigation, for example, revealed that a chain of nursing homes admitted residents with histories of substance use disorder, even though the facilities did not have enough trained staff to meet those residents' needs. Numerous overdoses occurred at those facilities," Campbell said. "Another tragic circumstance, a facility decided not to replace noncompliant bed rails because it was too expensive, leading to the death of a resident and serious injury to another. These are just a couple of examples of the neglect and tragedy that our elders face here in Massachusetts."
Gregorio asked lawmakers to modify the bill to ensure that any money the state gets through these lawsuits goes directly back into initiatives that would improve the quality of care in long-term care facilities.
Temporary Nurse Agencies
Nursing home workers who testified also urged lawmakers to add policies to the bill that would regulate travel and temporary nursing agencies.
When COVID-19 arrived in 2020, hospitals turned to traveling and temporary health care workers to fill gaps at facilities around the country that were overwhelmed. As of 2021, these contracted workers represented about 5 percent of hospital patient care labor costs in the state, according to the HPC report. Across Massachusetts, health care facilities paid $1.5 billion to these workers in fiscal 2022 -- a 154 percent increase over the previous year.
Travel nurses are not employed by a specific facility, but take temporary jobs in high-need areas. They are often paid more than their peers who are employed at hospitals or other care centers, and their wages spiked in 2020 and 2021, adding strain to health care facilities.
As of 2022, average wages for contracted nurses in Massachusetts were nearly double the average wage of employed nurses.
"Me and many of my coworkers are asking ourselves, since temp agency workers are being paid way better, why not go work for an agency when I can't afford a $2,000 per month two bedroom in Boston," said Joanne Edmond, a CNA at Next Step Wedgemere in Taunton.
She added, "At Wedgemere, when agency CNAs show up to work, they're often late and have a bad attitude. Many of them take long breaks and every hour they'll be out smoking. They leave right after their shift not doing their paperwork and the regular employees have to do it for them."
Edmond, and several other nursing home-employed nurses, said the temporary nurses often did not provide as compassionate care to the elderly and that their patients' continuity of care was disrupted by the churn of workers in and out of facilities.
This issue has also caught the attention of the HPC, Attorney General Campbell -- who sent an advisory last month to temporary nurse agencies that she said may be price gouging -- and Secretary of Health and Human Services Secretary Kate Walsh, who said "usurious travel agency contracts... hurt everybody."
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