Image of female nurse using telephone in office

The leader of one of the nation’s largest skilled nursing organizations Tuesday pushed back against a recent popular narrative about understaffing, reiterating concerns about Medicaid pay that continues to undercut provider efforts to recruit and retain workers. 

“Medicaid is woefully inadequate in every state, doesn’t cover the cost of care, and when you are not covering the cost of care, you’re not enabling the provider to pay their staff what they should be paid,” LeadingAge CEO and President Katie Smith Sloan told McKnight’s Long-Term Care News Tuesday.

“We’ve been advocating for quite a while the importance of reimbursing so that nursing homes can pay a livable wage to their staff so they don’t have to work two jobs. Until we address the funding issue we will continue to be challenged.”

Sloan’s comments came days after a USA Today investigation into nursing home staffing levels drew swift rebukes from other nursing home providers groups, who called the coverage unfair, reliant on the wrong policies and woefully lacking in nuance. The piece mentioned Medicaid rates only in passing, while portraying providers as greedy profiteers.

On Monday, Sloan responded directly to the report with a letter posted on the LeadingAge website.

“We’re all facing staffing challenges with hiring staff to work in nursing homes which manifests itself in lots of ways but the most significant is in occupancy,” she said to McKnight’s. “Our members tell me that if they don’t have enough staff they turn away residents. They simply don’t agree to provide services to them if they can’t staff to an adequate level and provide quality care.”

Adequate funding through fair reimbursement is critical to pay a livable wage to hire and retain workers, she said. A staffing mandate expected in 2023 will not magically attract the workforce necessary to satisfy the mandate.

Sloan’s organization has advocated for raising Medicaid reimbursement rates to cover the cost of care, and government commitments to investments in programs to increase the pool of potential workers coupled with Administration-supported policies on immigration reform, passed by Congress. 

“Reimbursement, which is providers’ primary source of support to pay for staff, is funded through Medicaid. States should be paying an adequate rate, and the issue is defining adequacy,” said Sloan. “Right now there’s nothing close to adequacy.”

Human resources puzzle

Recruitment is one piece of the puzzle, said Sloan, and retention is another. She cited one LeadingAge member who employs a “joyologist.”

“That person’s sole job is to help onboard new staff, mentor them, be a friend and guide to them, to make them feel most welcome,” Sloan said. “That job doesn’t stop after six weeks, it continues. The focus is we’ve got to invest in retention, we’ve got to invest in culture, and this is their way of doing that. We’re seeing an enormous amount of energy and creativity going into retention strategies.”

But for the time being, and likely into the future, there simply aren’t enough candidates to fill all open positions that would be needed to meet potential mandated hours.

“Regulation must include provisions that allow an employer to demonstrate they have tried in good faith to hire workers, but no one has applied,” she said. “When that is the case, providers should not be cited.”