Few long-term care providers that I know would begrudge their caregivers a living wage. It is a matter of enlightened self-interest. Continuity of care is a hallmark of quality. Lower wages create turnover and recruitment challenges.
Yet, too often, it is not the providers denying those caregivers their living wage dreams — it is policymakers. Even policymakers trumpeting “15 Now!” – or purporting to favor gender wage equity – are content with a long-term care system where Medicaid reimbursement depresses wages for nursing assistants. Ninety-one percent of that workforce are women, making an average of $12.84 an hour, nationally according to data from the Paraprofessional Health Institute.
Consider the state of Washington. It has a minimum wage is $12 an hour, and will rise to $13.50 next January. This sounds very auspicious for the certified nursing assistants who serve close to 10,000 Washington nursing home residents on Medicaid, especially given that state law prescribes minimum staffing requirements too.
However, under state law the nursing home reimbursement is based upon old costs that do not keep pace with minimum wage increases. A wave of nursing home closures has included Keiro Northwest Rehabilitation and Care Center, a nonprofit providing culturally-competent care to Seattle’s Asian and Pacific Islander community since 1976. In closing, Keiro cited Seattle’s minimum wage, already $15 an hour, as one of its challenges. That wage rate, effective this year, isn’t reflected in the state’s lagging Medicaid reimbursement. The state’s Long-Term Care Ombudsman Program joined sector representatives in a letter to legislators sounding the alarm. The letter noted that Medicaid reimbursement, at its worse, can lag 42 months behind the current cost of care.
We also cannot forget a facility’s support staff. Those providing dietary, housekeeping and maintenance support are also essential to the caregiving environment. Yet how are facilities to compete with the service economy if the state will not keep its Medicaid payments reflective of rising wage costs?
The irony is that for any public works contract in Washington the state would pay the prevailing wage for workers, under a wage schedule updated twice a year. Thus, although Vashon Community Care, a nonprofit, had to close Vashon Island’s only nursing home due to Medicaid operating losses and reported staffing challenges. This led to the facility using high-cost agency workers (a common-enough nursing home death spiral). Meanwhile, a highway project flagger on Vashon Island would be paid a prevailing wage of $41.45 an hour.
The purpose of this comparison is not to suggest the flagger does not deserve generous compensation. But why isn’t there a similar logic applied to caring for the state’s most vulnerable clients? Why do we not value those workers too? Might it have something to do with them being overwhelmingly women and predominantly non-white?
We are on an unsustainable trajectory for long-term care if even a progressive state like Washington is faltering. This must be a subject of debate in the 2020 presidential election, and there are some signs candidates are waking up to it. Minnesota Sen. Amy Klobuchar, for example, has posted ideas such as the need to “[s]upport a world class long-term care workforce, increase long-term care options, and tackle disparities in long-term care. This includes “increasing wages” – suggesting a new role for a federal government that has too long been a sort of absentee landlord when it comes to the federal-state Medicaid partnership.
New Jersey Sen. Cory Booker would reportedly “pay long-term care workers at least $15 an hour and extend them full workplace benefits.”
It’s a start. For those working in long-term care, it is well past time for progressive rhetoric to be matched with reality.
Brendan W. Williams is the President and CEO of the New Hampshire Health Care Association.