Staffing in nursing homes is a chronic problem that has been greatly exacerbated by the COVID-19 pandemic and is expected to get worse. Staff shortages, high turnover and the necessity to often work two jobs to make ends meet pose severe and immediate risks to nursing home residents, as well as to staff.

The immediate, short-term substantive solution is to increase certified nurse assistant wages to a living wage.

The Live Oak Project, an initiative of Pioneer Network and Live Oak Institute, is proposing a doable plan to provide an equitable wage for the important work CNAs do and to galvanize support to achieve this goal. We are working with a broad coalition of consumers, advocates, provider and professional associations, labor unions, elder organizations and policy influencers to light a fire on this issue.

Our focus is on CNAs because they have the greatest contact with and impact on the life of each person receiving care in a nursing home and are most at risk of catching and spreading communicable disease. Of all direct caregivers, they generally have the highest rate of turnover, and the pandemic, which has taken a tragic toll on nursing home residents, has also had a devastating impact on these direct care workers.

Poor wages for direct care staff is a nationwide problem caused by Medicaid reimbursement that is so low that it does not sufficiently support higher wages for CNAs. So, the solution needs to be primarily federally driven, especially since state budgets have been strained by the pandemic.

We are proposing the following, four-pronged solution to sow the seeds of a possible legislative fix, one that addresses the urgent need for an equitable wage for CNAs:  

  1. Federal legislative action to provide a direct Medicaid pass-through to providers to be used exclusively for CNA wages.
  2. A federal match for the CNA pass-through up to100%, which is higher than the standard federal match formula. This is needed to address states’ fiscal challenges due to the pandemic, as well as constitutional requirements on budgeting.
  3. A resulting 25% pay increase over four years, with a 10% increase the first year and additional 5% each of the next three years.
  4. Verification of the application of the pass-through to CNA wages through an annual cost report subject to audit. Money used for purposes other than CNA wages would be returned.

The fiscal impact of this initiative has to be determined. Regardless of cost, the devastating impact of the pandemic in nursing homes has demonstrated the urgent need for action to stabilize the CNA workforce.

It is an investment in eldercare that will reap dividends in the long run. Better and stable staffing on the CNA level leads to more efficient operations, less use of expensive outside agency staffing, reduced risk of unnecessary hospitalizations and other potential savings.  

It goes without saying that our proposed solution will not solve the entirety of the immense problems facing nursing homes. But it will significantly contribute to reduced turnover and staff shortages making it more feasible to effectively manage epidemic outbreaks, support more consistent assignments, improve care in nursing homes in poor and working class communities, reduce unnecessary hospitalizations and — most importantly — improve quality of care and quality of life for residents.

The need transcends politics. We hope for a bi-partisan initiative for the 2021 legislative session. 

We are seeking only to plant a seed of what’s possible, and we fervently hope some meaningful action will arise. Our goal is obviously daunting. However, as a starting point we can all agree: We have a problem and in this COVID-19 environment, it is an existential one. 

Jeff Jerebker was the president and CEO of Pinon Management, a company that managed proprietary, nonprofit and government nursing homes in Colorado and New Mexico for over 30 years. He is a former board member of Pioneer Network and Eden Alternative and co-founder of the Live Oak Project, an initiative of Pioneer Network and Live Oak Institute devoted to responding to the COVID-19 catastrophe in nursing homes by transforming the Medicaid/Medicare driven systems of long-term care.