(Courtesy MedTimes) — Across the country, thousands of people in nursing homes are dying from COVID-19. In at least 20 states, more than half of COVID-19 deaths have been linked to long-term care facilities, according to the Kaiser Family Foundation.
The COVID-19 pandemic has put our nursing homes in the national spotlight. Severe staffing shortages and inadequate protection of both patients and staff have created a nightmare for our vulnerable senior citizens. Numerous analyses have found low staffing to be a predictor of whether nursing homes had COVID-19 outbreaks and how large they became.
The White House coronavirus task force is a great step in controlling the pandemic. But we must create a sub-task force to address nursing homes and their staffing needs. We need higher standards for staffing requirements, accompanied by investments in nursing homes, to stem the crisis.
Currently, federal nurse staffing requirements call for nursing homes to have one registered nurse on staff at least 8 hours per day and one licensed nurse (either a registered nurse or licensed practical nurse) on staff 24/7. Meeting this requirement is one of the key metrics that allows nursing homes to get a five-star rating by the Centers for Medicare & Medicaid Services (CMS).
But this is not nearly enough. Experts suggest that staffing requirements need to take into account the number of residents in the facility and severity of their needs. CMS recommends each nursing home resident get 4 hours and 6 minutes of direct care a day. But only 75% of U.S. nursing homes meet this requirement, according to the Kaiser Family Foundation.
To improve staffing, we need to increase wages for nursing home jobs. Low reimbursement rates by Medicaid, the primary payer for nursing home residents, have limited the ability of nursing homes to raise wages for workers. Short-term fixes have included supplemental Medicaid managed care “pass-through” payments, which CMS ended in 2016, and state emergency policies during the pandemic to temporarily raise rates. A permanent fix would be to increase Medicaid nursing home reimbursement rates to at least be on par with the more generous Medicare rates.
We need to create career development opportunities for nursing home workers. Nursing aides, who constitute over one-third of the nursing home workforce, are required to only have a high school degree and a federal minimum of 75 hours of training. States may set higher requirements. Nursing aide jobs are in high demand and should be a target of job investment programs funded under the federal Workforce Innovation and Opportunities Act (WIOA). State workforce boards could be engaged as partners with the nursing home industry to develop a stepped career pathway, necessary for WIOA investment, through the use of apprenticeships that could lead to higher-wage jobs, such as a licensed practical nurse.
We need to make nursing homes less dangerous places to work. Nursing homes need to have high priority in the distribution of personal protective equipment and testing. Nursing home workers need mandatory paid sick leave benefits and must be included in public health insurance programs. Too often these workers are without health insurance or sick leave benefits, causing some to work while symptomatic.
Staffing as a challenge for nursing homes is nothing new, but it is the elephant in the room that needs to be addressed during this crisis. We have long known the problems, and the solutions are increasingly clear. We now need the political will and leadership to safeguard our most vulnerable citizens.
Bianca K. Frogner, PhD, is an associate professor of family medicine at the University of Washington School of Medicine, and director of the UW Center for Health Workforce Studies, one of nine such federally funded centers around the country. Susan M. Skillman, MS, is the senior deputy director of the UW Center for Health Workforce Studies.
Photo Courtesy of Georg Arthur Pflueger.