Direct care workers were the latest to meet with federal agencies, following the unveiling of Biden’s nursing home package. Ownership accountability, adequate staffing hours and higher pay are among the main asks of nursing home staff that have stayed on through the pandemic.
Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure stressed the importance of direct care staff voices during a meeting on Wednesday, as the agency builds on reform initiatives first outlined by the Biden administration in February.
Just under 300 direct care workers across the country tuned in for a Facebook livestream event featuring Brooks-LaSure and hosted by the Service Employees International Union (SEIU); the conversation further delved into what meaningful changes staff would like to see from such reforms.
Three CNAs and one licensed practical nurse (LPN) joined Brooks-LaSure on the livestream.
The CMS administrator appreciated the “specific and actionable” issues brought up by SEIU members, as the agency continues its health equity strategy and making sure officials are “lifting up every part of our underserved population.”
Reforms must move forward with perspective from those with lived experience, Brooks-LaSure said.
“We are really focused on minimum staffing requirements for residents but also for workers to ensure their opportunities for career advancement,” said Brooks-LaSure. “We’re ready to focus on making sure we’re transparent so that there’s transparency in nursing homes. Also ownership so that residents can escalate issues as they happen. We’re also rethinking how we approach nursing homes that are not meeting the standards that we want them to meet.”
A rare opportunity
Four SEIU members got the rare opportunity to speak directly with Brooks-LaSure, highlighting aspects of the Biden reform they’d like to see become a reality, and how their positions inform their perspective.
“We need a real change. Safe staffing, better pay, more training – owners must be held accountable for how they treat the residents and the staff,” Tamara Blue, a CNA in Michigan, told Brooks-LaSure. “This is urgent; the population is only getting older.”
The pandemic “ripped the band-aid right off” of what many health care workers have long considered short staffing, added Julie Martinez, an LPN in New York.
Nursing home staff face harrowing staffing ratios, Martinez told Brooks-LaSure, sometimes two CNAs per 40 residents, or one nurse per 40 residents.
Brooks-LaSure mentioned her first government assignment was on nursing home staffing – in 1999.
“These issues are not new … it’s been an issue so long standing, making sure that people who reside in nursing homes have the care that they need,” said Brooks-LaSure.
Barbara Coleman, a CNA in Pennsylvania, urges state legislators to pass a safe staffing bill, in addition to advocating for staffing minimum hours at a federal level.
“The standards haven’t changed in over 25 years,” Coleman said. “When you consider that a CNA works eight hours but provides care to 16 or more residents in a shift, the math doesn’t add up.”
Adelina Ramos, a CNA in Rhode Island, said she was optimistic when the state implemented a minimum staffing standard, but there weren’t enough CNAs to fill ratios established by the law.
“We went back to square one,” Ramos said. “This job is stressful already and we have felt so disposable for so long. People just can’t take anymore so they find work where they pay better. They go somewhere where they don’t have to face that every day.”
About 160,000 nursing home workers belong to SEIU, according to SEIU Executive Vice President Leslie Frane.
Biden’s initiatives have the potential to be “truly game changing,” Frane added.
Association members meet with CMS, HHS
Aging service provider organizations and select members met with Brooks-LaSure last week as well, kicking off a series of meetings with the American Health Care Association (AHCA) to discuss potential impacts the Biden reforms will have on the industry.
AHCA penned a letter to Health and Human Services (HHS) in early March requesting such meetings so federal officials could hear directly from industry leaders about quality efforts already taking place, and underscore critical staffing challenges facing facilities.
The agency’s due diligence prior to reform announcements didn’t extend to providers, Parkinson said, a “glaring mistake” the organization hoped to rectify by getting its members a meeting with CMS and HHS.
“We had four of our outstanding members, small and large, five-star buildings from various parts around the country that each spent five, six minutes just explaining to the administrator how committed they are to quality and secondly, how impossible it is to find workers,” said Parkinson during a fireside chat with Skilled Nursing News last week. “Two of these entities have closed or are closing buildings because they can’t find workers.”
In a later statement, Parkinson said they association appreciated the opportunity to meet with federal officials, and have its members share firsthand what is happening in long-term care.
While the National Association of Health Care Assistants (NAHCA) met with Health and Human Services (HHS) Secretary Xavier Becerra, the organization has yet to discuss the Biden reforms with CMS.
“Historically, CNAs and NAHCA have not been included in high level discussions, even when the primary topic of concern is directly related to their important role and their ability to provide quality care and despite CNAs having firsthand and valuable input,” NAHCA Co-Founder and CEO Lori Porter said in a statement.
Porter believes the reforms – and the federal government’s willingness to listen to NAHCA and its members – is the first step toward a better workplace culture for CNAs. That includes a “wage they can raise their families on” and enough peers working beside them to provide adequate care.
NAHCA represents 26,000 CNAs across the country.
LeadingAge, which represents nonprofit nursing homes, connected with Becerra and Brooks-LaSure in the same week.
“We’ve emphasized the importance of understanding the full picture of how our country supports old adults who need nursing home care — and to lead an all-of-government solution, which includes several parts of HHS — including CMS, HRSA and NIA — as well as the FTC, State, Homeland Security, HUD, Education, and Labor,” LeadingAge President and CEO Katie Smith Sloan said of the organization’s meetings with HHS and CMS. “This is not a CMS or even HHS-only issue.”
LeadingAge seeks to work with the agencies to meet the staffing crisis head-on, pay for quality care and apply quality improvement and measurements based on evidence, Smith Sloan said in an email to SNN.
“The country’s employment data is not painting an optimistic picture,” added Smith Sloan.
Just last month, the industry lost 2,500 jobs – skilled nursing overall has lost 241,000 workers, or 15.2% of its total workforce since the start of the pandemic, according to data published by the U.S. Bureau of Labor Statistics and highlighted by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).
“We’ve asked the administration to focus on ways to allow foreign nursing staff to help long-term care communities; expand the pipeline of applicants with training and apprenticeship programs; address price gouging by temporary staffing agencies and, above all else, support direct care workers with much-needed resources,” Smith Sloan wrote.
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