Any employee who is satisfied in their position is more engaged and productive. The healthcare industry is no different. This is not controversial or shocking. I am not going out on a limb when I talk about it. I am stating the obvious.
While there are steps a company can take to improve retention, like recognition and culture, better pay and benefits will always be a stronger retainer. But in a recent American Health Care Association (AHCA) survey, 81% of nursing homes said that higher reimbursements are necessary for better pay and benefits to become reality.
“In far too many states right now the reimbursement for Medicaid is dramatically less than the actual cost of taking care of people in nursing facilities.” – Mark Parkinson, AHCA President
As temporary relief measures such as the public health emergency (PHE) dry up, 12 states are looking to the future by enacting Medicaid add-ons that are tied to the end of the PHE. The hope from industry leaders and advocacy groups is that all 50 states revisit and adjust their Medicaid rates – not just looking at old numbers and attaching an inflation percentage to them – actually taking a close and detailed look at the cost of taking care of vulnerable residents in this setting.
CMS has encouraged states to specifically allocate Medicaid dollars toward improving staffing, but no measures have been made mandatory. CMS has the power to enact such a measure, so why not make this required and ensure that the reimbursement goes where it is needed most? As providers and advocacy groups push for rate increases to state officials, it’s important to provide realistic solutions.
For example, I think Illinois’ blueprint for advances in funding is on the right track. Of the $700 million increase in nursing home funding approved by the state earlier this year, much is allocated toward staffing — up to $350 million in staffing incentives and $83 million for Certified Nursing Assistant (CNA) compensation and support for workforce retention, tenure, promotion and training.
Florida added conditions to its rate increases, with a new minimum wage for all nursing center employees. They also increased Medicaid reimbursement rates by 7%, but only if they allow a public review of their financials, promoting much-needed transparency.
I cannot stress enough the importance of the need for higher reimbursements and ensuring these funds are allocated to the staff caring for this vulnerable population. Without it, the downward spiral toward ineffective care happens fast.
If a facility is at financial risk and cannot adequately support the staff, this rapidly leads to staff turnover. Now the facility is operating under a staffing shortage (not uncommon) which leads to the development of unsustainable working conditions where the staff are unable to provide high-quality care to the residents, creating burnout and poor mental health for the staff and poor care for the residents. This leads to more shortages, bad headlines, and worsening financial situations, exacerbating the entire cycle of diminishing resident care.
Rather than looking at the issues of quality of care, healthcare worker retention, healthcare worker shortage, underfunding, resident health, etc., as individual issues, we must realize these issues are all connected in a messy, convoluted web, and they must be addressed in an organized, multi-tiered approach that looks at the system of causes and outcomes as a whole.
In order to provide the safest environment for our residents, we need to provide the best environment for the staff. To do so, we need to increase pay and benefits so employees are not severely overworked and facilities are not understaffed.
To do this, we need reform at the level of lawmakers to not only look at the costs of what reimbursement covers but to change the way the industry must spend these reimbursements. This includes eliminating any self-dealing that may occur and establishing cost category reimbursement methods that require facilities to spend on targeted categories like staff and enacting direct care ratios, allowing specific portions of reimbursement to go directly toward the well-being of residents.
The well-being of the staff and residents is priority #1, and the only way to ensure the residents and healthcare workers are taken care of is by stepping back and seeing the bigger picture.
Buffy Lloyd-Krejci, DrPH, CIC, is the founder of IPCWell. Drawn to action to improve the infection prevention landscape for these communities, she utilized her over two decades of experience in the healthcare field and her doctorate in public health (DrPH) to launch IPCWell. Dr. Buffy and her team have provided training, education, and technical assistance (both in person and virtually) to hundreds of congregate care facilities throughout the COVID-19 pandemic.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
