Jacqueline Vance, RNC, CDONA/LTC

I think a lot of us were a little ticked off with the State of the Union address and the administration’s focus on improving the quality of care provided in America’s nursing homes. 

We all know we have lost hundreds of thousands of workers since the beginning of the pandemic and so far, we’re not getting them back. I mean, why come back to the basically hardest job on the planet when you can make more money at McDonald’s?

Yes, it is extremely demoralizing that we’re getting blamed that the MOST vulnerable citizens in our country died in our facilities when we got ZERO government support or prioritization. You all know what I’m talking about. No PPE, no testing, no stopping the financial rape by agencies, no help in the beginning at all. But whoa, Nelly! Plenty of blame.

So, yeah, now is a super great time to enact minimum staffing standards so we can pull nursing staff out of our behinds and pay them with, uh, what again since our reimbursement comes from the same government that wants to enact these standards and penalties? Oh, and did I mention more financial penalties (doesn’t hurt to point that out twice)? Again, let the beatings continue till the morale improves.

I have this fictional conversation in my head with the administration and leadership. It goes kind of like this:

Me: OK, I’m just trying to get a few things straight. You all feel like it is our fault that so many seniors died in our care even though you did not prioritize our setting for public health. And, I quote the American Health Care Association here, “There were a series of horrible public health policy decisions that left SNF providers without testing, personal protective equipment (PPE), staffing support, and at times, COVID treatments.”

Administration/CMS: Yep, all your fault. We are showing how much we care about our nation’s elders by beating you down and further demoralizing you.

Me: OK so let’s talk about staffing.  At a time when we have a mass exodus from the sector, and despite raising wages to the point of bankruptcy, you want to set a minimum staffing standard. Like now? 

Administration/CMS: Of course, we care about our nation’s elders.

Me: But like where do we get them? We can’t compete with the agencies that you have done nothing about price gouging. We can’t compete with the retail sector because that can actually raise their costs/reimbursement to cover higher wages.

Administration/CMS: Not our problem, we must show that we care about our nation’s elders.

Me: Um, you do realize that you set our reimbursement rates, right? And you do realize that we are paying more for everything. Like our food costs have gone up around 15%, gloves that once cost us 4 cents now cost 11 cents. I mean everything is costing us more. So, where do we get the money from to pay even higher wages?

Administration/CMS: Not our problem, we must show that we care about our nation’s elders. That’s why we keep giving you payment penalties to show the nation we care. 

Me: So, let me get this straight: You won’t reimburse us to the level we need, to do all the things we need to do, we aren’t prioritized, you keep financially penalizing us, all to show you care. Like how do we provide what our residents and patients need without money?

Administration/CMS: It will magically happen. Government accounting and all. You’ll figure it out, and we must show that we care about our nation’s elders.

Me: So, your fix is to basically kill off nursing homes. 

Administration/CMS: Well, in our efforts to punish the small number of bad actors, we have to approach all the same so if the sector doesn’t survive… not our fault. Otherwise, signaling out the few bad actors would make sense. When did the government ever do that?

Me: (Smack my head and walk away.)

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities, LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real-life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates. 

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.