To Stop COVID-19 in Nursing Homes and Honor Workers, Federal Aid Must Include Direct Payments to Caregivers

Six months into the coronavirus crisis, the nation has settled into an uneasy return to semi-normalcy, with many schools reopening, sports airing on television every night, and most people learning to live with socializing in small groups while wearing masks and keeping plenty of distance.

But for nursing home residents already ravaged by COVID-19, any semblance of normalcy is months, if not years, away — and that’s not even accounting for an oncoming flu season that will add even more stress and strain onto a long-term care landscape that has already endured so much sickness and death.

The solutions have been in front of us for some time, but implementing them has been a challenge: Operators still must scramble to secure adequate supplies of personal protective equipment (PPE), concerns about price markups loom over a federal point-of-care testing push, and states struggle to balance the need for in-person family visits with the omnipresent fear of more outbreaks.

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Staffing, always a major stressor even in pre-pandemic times, has become a critical pain point. Workers who test positive must remain quarantined for weeks until they recover, creating gaps in schedules; staff members who live with elderly or immunocompromised relatives have understandably looked for work elsewhere instead of accepting the risk; and remaining frontline caregivers, who must continue to live in the world outside of locked-down nursing homes, can unwittingly bring the virus into their workplaces.

The connection between the level of community spread and risk of nursing home outbreaks is well-established by this point. The federal government’s strict new testing plan for workers is based entirely on that correlation, with county-level positivity rates dictating exactly how often staffers must be tested.

It’s a good start, and if implemented properly, it will save lives. But it’s not enough. With Congress back in session and debating a follow-up to the $2 trillion CARES Act, it’s time to call for direct and indefinite cash support to frontline nursing home workers.

We’ve known since the very first outbreak of COVID-19 in a long-term care facility that caregivers who work at multiple sites can serve as a primary vector of coronavirus transmission; the Centers for Disease Control & Prevention (CDC) confirmed that correlation in a report issued March 18, during the earliest days of mass lockdowns.

And yet it’s still a problem as nursing homes work to fill positions that have become the most dangerous in America, according to one analysis, far outstripping historically treacherous work such as logging and commercial fishing.

Nursing home staff have always been underpaid for the intimate, vital, and difficult work they perform. So they take extra shifts at multiple facilities, tirelessly doing the work that so many others don’t.

Since March, they have reported for every shift knowing that they could potentially contract or spread a deadly virus, and yet they continue to show up — often because they feel a calling and a duty to care for the most vulnerable, but also because they have families to support.

I have felt deeply the emotional and mental toll of reporting on the waves of death and scattershot government response. But in the end, I’m a salaried employee with a job that allows me to stay at home, far away from the front lines of a once-in-a-lifetime crisis. Each evening, I can close my laptop and go on with my life in the new normal, without the looming fear of potentially contracting COVID-19 on the job — or the painful images of failing to comfort a resident confused about why his family hasn’t been able to visit in months.

Frontline caregivers, from administrators to CNAs, don’t have that luxury. It’s long past time for the industry and the federal government to care for them with direct coronavirus relief.

It’s true that billions have been sent from Washington to nursing home operators, with the express intent of covering elevated expenses related to COVID-19. But those expenses won’t be confined to a few months: Nursing homes will require access to rapid testing and levels of PPE well above pre-pandemic levels even after a vaccine is distributed, making coronavirus-related financial strain part of the industry’s new normal.

Then there’s the question of “bad apples,” which many leaders say cause most of the problems in long-term care. Undoubtedly there will be operators who decide not to pass the federal largesse down to caregivers in the form of bonuses or permanent raises. Even if some in the industry bristle at the negative portrayal of the space, and say it’s unfair, they can’t look away from that reality — and if even just one bad apple fails to provide for staffers, it’s a tragedy that should and can be avoided.

That’s why the industry must advocate for direct payments to nursing home staff as part of any future stimulus package. In a perfect world, this would take the form of weekly checks sent to workers’ homes, using existing IRS information on file, with a simple application process for newcomers: Submit a recent pay stub from your job at a nursing home, and you’re in the program until the pandemic ends or you find a different job.

First and foremost, both operators and the country have a moral obligation to support the selfless folks on the front lines. That doesn’t just mean free T-shirts or pizza or salutes on the local news — that means cash that they can use to support themselves and their families during a global pandemic.

Providing direct payments to caregivers is also simply good public health policy. Pay a worker a living wage — or, preferably, more than that — and she won’t have to take extra shifts at another facility and increase the chance of asymptomatic transmission. Even a twice-weekly testing mandate leaves five days for a staffer to contract the virus in the wider community, or another nursing home, and potentially pass it along. Plus, in addition to community spread, research has suggested that strong nurse staffing plays a role in preventing outbreaks and curbing deaths when cases do occur.

Federal hazard paychecks would also eliminate the “bad apples” problem, routing cash directly to workers without the danger of an interception by middlemen. The government cannot force investors and operators in the space to raise wages without piecemeal state-level legislative action — or an unlikely boost to the overall federal minimum wage, which has remained stagnant since 2009 — but they can circumvent that roadblock with a federal cash pipeline. Advocating for the inclusion of such payments in future stimulus bills will also help counter some of the criticism that operators, particularly those with a history of regulatory issues, have faced in receiving “no strings attached” cash from the federal government during the crisis.

And finally, it’s an investment in the future of the space. Wages aside, caregiving jobs have always been a tough sell — I certainly sympathize with the recruiters who must compete with other retail and service jobs that were less demanding even before the pandemic.

COVID-19 isn’t going away in the United States, and especially not in nursing homes, anytime soon. The post-acute and long-term care landscape is in desperate need of major structural reform; guaranteed sick time and increased baseline wages for vital caregiving roles must be a primary pillar of such efforts.

But that takes time, and any sweeping changes proposed today will not benefit the current generation of elders who require its services or the workers who serve them.

It’s an old saw that crisis reveals people’s true characters, and the choices that operators and the government make to bolster the industry will have a permanent impact on the sector, and seniors, for years to come.

It’s long past due for workers to be at the center of those decisions.