Long-term care and CMS workers occupy common ground
Long-term care workers and Centers for Medicare & Medicaid Services employees might have a lot in common — and that's not entirely good news.
This was my conclusion after seeing this year's federal government Employee Viewpoint Survey, conducted by the Office of Personnel Management. The survey found federal workers are “strong,” “resolute” and “devoted,” wrote OPM Director Katherine Archuleta. However, these employees must contend with negative public opinion, and the agencies they work for face budgetary pressures, forcing workers “to do more with less.” This translates to a “future of uncertainty” and federal workers' growing weariness of “policies and practices affecting … operations and resources.”
In other words, this is a group of workers who believe in what they do, who continue to put in long hours without getting much public recognition (or while facing outright hostility), and who toil on despite knowing that their pay and access to needed job-related resources are jeopardized by shrinking budgets.
If this description fits both LTC workers and federal employees, it's in part because they are affected by many of the same policies. The across-the-board budget cuts that lopped 2% off providers' Medicare reimbursements also resulted in pay cuts and furloughs at government agencies. Archuleta was blunt about these sequestration cuts:
“The survey results serve as an important warning about the long-term consequences of the sequestration and budget uncertainty. Without a more predictable and responsible budget situation, we risk losing our most talented employees, as well as hurting our ability to recruit top talent for the future.”
Note that the survey was administered prior to the government shutdown, which, it's safe to say, did not improve federal workers' morale. The survey also preceded the disastrous rollout of the online federal health insurance marketplace, which was a CMS project. While it won't show how the healthcare.gov debacle has affected employee viewpoints at CMS, a more granular report due out Dec. 18 will provide CMS-specific data. I'll be surprised if positive trends from last year hold.
The OPM report did provide some recommendations for federal managers, which might be applicable in long-term care settings as well. With money tight, managers cannot rely on financial incentives to motivate their workers — and, in fact, they may have to find ways to keep workers happy despite their increasing dissatisfaction with pay and benefits. It appears federal managers are doing so by focusing on workplace flexibility and treating workers with respect. The only survey items that showed increases government-wide were supervisory support for work-life balance, employees feeling respected by managers, and satisfaction with telework initiatives.
I think it's worth considering the parallels between LTC and federal workers not only to glean lessons about how to address some shared challenges, but because CMS and providers so often are cast as combatants. Granted, the main provider associations frequently tout their strong and cooperative relationship with CMS, and I'm not so cynical that I think this is all just lip service. But, even when they're upset about particular policies, it may be easier for officials at huge lobbying organizations to be circumspect about CMS than it is for frontline caregivers.
It's these caregivers who have to contend on a daily basis with byzantine regulations and requirements, sometimes crushing documentation burdens, the stresses of surveys and the confusion of the appeals process. I've listened to enough Open Door Forum calls to get a sense of caregivers' deep frustration at trying to get the answer to a seemingly simple (or astonishingly complex) question, and can understand why — in spite of CMS officials' unfailing politeness — providers might feel that in CMS they don't have partners as much as opponents forcing them to navigate a Kafka-esque bureaucracy.
Don't get me wrong, I'm not trying to make a special plea for LTC staff to cut federal workers slack. I'm flabbergasted at the extent of the healthcare.gov failure, and was glad to hear experts recently state that long-term care reform should not be too much in the hands of CMS.
But perhaps I'm moved by the spirit of the holidays, and I do think this is a good time to be thankful for government workers. The shutdown might seem like ancient history already, but it reminded us that CMS and other agencies do real good. The OPM survey reminds us that many federal employees are motivated by similar principles as long-term care workers, as they seek to serve others by sticking it out in the public sector despite significant challenges. If these reminders foster a little bit of added collegiality between long-term care workers and regulators, that could help build morale for these two groups that both could use, and deserve, a boost.
Tim Mullaney is Staff Writer at McKnight's. Follow him @TimMullaneyLTC.