Not Enough Money
Worker advocates say long-term care nurses are underpaid. All types of nurses earn less in nursing homes than in hospitals, and low-paid nurse aides can struggle to afford rent and child care.
“We estimate that about 44% of direct care workers live in or near poverty,” said Robert Espinoza, vice president of policy at PHI, a New York City-based organization that works to improve direct care jobs. PHI’s estimate includes people who provide hands-on care in nursing homes, assisted living facilities, residential facilities for people with disabilities and clients’ own homes.
The average nurse aide earns about $13 an hour in a nursing home or assisted living center, according to the U.S. Bureau of Labor Statistics.
Many long-term care facilities have boosted hourly pay during the pandemic and at least one state, Arkansas, has won permission from federal regulators to offer bonuses: $250 a week for full-time direct care workers, and $500 a week for full-time workers who are caring for a patient who has tested positive for the coronavirus.
Industry groups acknowledge that pay is a problem but say employers’ hands are tied, because their revenue depends on how much states pay them to care for people on Medicaid, the government health insurance program for low-income and disabled people.
In Massachusetts, 7 in 10 nursing home residents rely on Medicaid, Chen said, so state reimbursements dictate business revenue and therefore worker pay. “We can’t make these investments unless the state really makes these investments with us,” she said.
State lawmakers, in turn, say plummeting tax collections will make it hard to increase Medicaid reimbursements anytime soon. Massachusetts’ fiscal 2021 revenue may be 15% lower than expected, according to the nonpartisan Massachusetts Taxpayers Foundation, a Boston-based research organization.
“Staffing and staff pay are at the very center of what we need to do,” said state Sen. Patricia Jehlen, a Democrat and Senate chair of the Joint Committee on Elder Affairs. She said she hopes lawmakers can improve Medicaid rates for long-term care facilities and better police how facilities spend the money.
But in the current budget environment, she said, “it’s going to be a very big challenge.”
Employers can improve direct care jobs without increasing hourly pay, said Katie Lynn-Vecqueray, director of employer membership at WorkLife Partnership, a Denver-based organization that helps employers retain employees.
Long-term care facilities can give care workers free meals, create support groups to help them manage stress or let them take mental health days, for instance. After low pay, Lynn-Vecqueray said, stress is a major reason why direct care workers quit.
Despite the pressure he and nurses like him are under now, Bondah said, he can’t think of any long-term care workers who have quit. He has been a nurse for 20 years, and he said he feels a duty to show people empathy and appreciation at the end of their lives.
“We need to give them good care,” he said of the residents he looks after. “We need to love them.”
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