There is a crisis in our nation’s nursing homes. The pandemic showed us what happens when access to care is compromised, and we are calling on a staffing solution that brings more workers to the industry.

But four months after the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for a federal minimum staffing standard — an obvious first step in fixing the care crisis — I’ve seen countless industry stakeholders speak out against such a measure. 

Many of those opposing the CMS rule claim that mandatory ratios will force facilities to close, especially in rural and underserved communities. They say that meeting the standards will be impossible because of inadequate revenue, limited resources and empty beds. They say they won’t be able to attract enough workers to staff shifts as required by law, because nobody wants to work these jobs. 

Staffing standards work. When nursing home owners are held to strict guidelines for assessing each facility’s acute needs and allocating taxpayer dollars, a total sea change is possible. A member of our union, Lori Irvin, can attest to this. 

Lori has worked as a certified nursing assistant in Altoona, Pa., for nearly 40 years. When Pennsylvania instituted improved staffing standards in June 2023, quality of life for residents and workers at her facility improved in ways Lori had never seen before. 

Management course corrected. Wages increased dramatically with a new union contract, and management went on a hiring spree to meet the new requirements. The facility welcomed new workers, many who specifically applied to work there because of its newly-instated competitive wages, benefits and incentives. Lori used to care for over 50 residents in her unit on night shift with just one other aide, and some nights she worked alone for a few hours. Because of management’s commitment to following the law, her facility schedules three aides every night. Lori told me the change made her look forward to going to work.

During the pandemic, more than 400,000 nursing home workers left the industry. Burned out and tired of pushing themselves to their limits without the respect, protection and pay they deserve, nursing home workers made the difficult decision to leave the jobs and residents they love in pursuit of more sustainable conditions. Amazingly, Lori has seen many of her former colleagues return to work now that mandatory ratios are in place. 

When it comes to care, we know that one size does not fit all — and the same goes for nursing home staffing. CMS proposes to strengthen the process nursing homes use to assess their staffing needs, with the expectation that if residents of an individual facility have higher acuity needs, a higher staffing level would be required. If nursing home workers are heroes (and they are), we must set standards that will respect the work they do, no matter where they live or who their residents are.

Our communities deserve transparency about where their tax dollars are going when it comes to long term care, but many nursing home owners have proven they cannot be trusted to be good financial stewards. During the pandemic, Pennsylvania nursing homes received hundreds of millions in public dollars; however, it’s unclear how much of that money went to patient care versus corporate profits.

I’ve spoken with hundreds of workers and residents who wondered why their companies can afford to buy new facilities to expand their business portfolios and bring in high-cost agency workers, but can’t afford to make the necessary investments in care and care jobs that would attract more workers to this field. 

We have to stop blaming the nursing home crisis on a lack of workers. This crisis stems from a system where bad actors can skirt the rules with little accountability, setting up elaborate third-party transactions to make it appear their finances are in dire straits, when in fact the money is going to the same people in the end — all at the expense of caregivers and residents.

In order to be successful under federal staffing standards, nursing home owners will need to reevaluate how their facilities operate and how money is allocated. Above all else, companies must invest in their workers, and make nursing home jobs good, union jobs. That means raising wages, expanding benefits, and creating an environment that affords residents the safe, consistent, skilled and individualized care we promise to provide. 

It’s up to nursing home owners to change the way people think about nursing home jobs. And a federal minimum staffing standard is the obvious first step in that pursuit. 

Matthew Yarnell is the president of SEIU Healthcare Pennsylvania, the largest union of caregivers in Pennsylvania, and a former certified nursing assistant at a long-term care facility.

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.

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