Tag Archives: nursing home workers

Solving the Nursing Home Turnover Crisis

nurse turnover, nursing home crisis, healthcare, certified nursing assistant

March 3, 2021

New Orleans      Nursing homes have been a flashpoint during the pandemic as death rates for residents and staff have been tragic and appalling. The situation was seen as so critical that vaccines were prioritized for the homes, where now the struggle is getting sufficient staff to participate, even as families have pushed for loved ones to get protection so that they can return to visit and assist in care. Families and the elderly themselves are increasingly resistant to moving into nursing homes as the pandemic continues, yet the demand for reforms have not been as loud and strident as the situation would seem to demand.

A recent study by academics at UCLA and Harvard received some deserved attention by looking at the impact of turnover of nursing staff in the homes as perhaps an underlying part of the crisis. The topline of the story was that after examining the payroll data from the Center for Medicaid and Medicare Services (CMS) the average turnover was 128% in the more than 15,600 homes for which data was available. This current turnover more than doubles previous studies.

The report was graciously shared with Local 100 United Labor Unions by its lead author, Professor Ashvin Gandhi, and its conclusions, from a union perspective, are almost an “I told you so” moment from countless years of recurring bargaining sessions with employers at the homes that we represent. Inadequate wages and benefits were felt to be a major trigger for the turnover. Certified nursing assistants (CNAs) on the firing line experienced universally high turnover rates, and provide the bulk of nursing home staffing, despite usually poor wages and benefits.

The authors found three patterns emerging from the data on turnover:

  • There was a direct correlation between turnover and regions with lower per capita income indicating “inadequate pay.”
  • Turnover tended to be higher in for-profit homes and within nursing home chains where support for staff was a lower priority.
  • A higher Medicaid census of clients because of its lower reimbursement rates meant a reduced capacity to provide adequate pay and benefits.

Looking at the geography of turnover was disturbing as well. States like Texas and Oklahoma drug the bottom with turnover rates between 118 and 165% annually. Arkansas and Louisiana, where we represent nursing home workers, ranged between 98 and 118%. The lack of job alternatives may account for the relatively better turnover in Mississippi, Alabama, and Georgia in the 39 to 73% range. The best states were California, Alaska, Wisconsin, New York, New Jersey, and Connecticut. I might add that unionization rates are somewhat better in some of those states as are nonprofit concentrations.

The authors weren’t singing “Solidarity Forever,” but their recommendations for reform would fit nicely in union contracts and lobbying campaigns. They suggested that the feds and states earmark increased reimbursement to improved wages and benefits. They also felt including nursing workers in health insurance programs and not penalizing them for sick leave would make a huge difference. Amen!

In the stages of mourning for nursing home deaths, now should be time to demand change at every level.


Some Changes the Coronavirus Should Bring

Pearl River     In the Age of Trump and the Time of the Coronavirus, there seems to be constant speculation about what changes in our society, habits, and government might be permanent given our collective experience.  Much of this is hyperbole.  One pundit argued that he went “to sleep in America and woke up in democratic socialist Europe.”  Oh, if dreams could come true!  Let’s instead talk about lessons we should learn in this crisis, and things that should absolutely change in the wake of this crisis.

The Affordable Care Act is now ten years old, celebrating its anniversary during the lockdown.  No matter Trump’s rhetoric and Mitch McConnell’s Senate Republican caucus, can anyone make the case that the private health insurance and the patchwork quilt of state health coverage is adequate for our people?  The elimination of mandatory coverage left our hospital network damaged, albeit their greedy pricing of their services, drugs, and the like are major players as well, forced mergers and left us with too many sick and not enough beds, equipment, and personnel.  Millions in states across the country are facing this crisis without any insurance.  That has to change.

How could we not learn that the internet has to become a public utility?  How could we not realize that we finally have to take this matter out of the hands of the telecoms and the pattycake FCC voluntary programs and eliminate the digital divide, here and around the world?  How can all the ideologues who want to argue that education is the answer, despite the facts, maintain their position as the country from elementary to college is pushed into on-line learning, leaving lower income families even farther behind?   Put this near the top of the list.

Living wages, paid sick leave, real unemployment benefits, the play pretend that gig workers are not employees, are all things that we have once again been taught have to be part of the safety net for everyone, especially lower waged workers and their families.   The failure of government in this crisis has to end the argument that somehow the private sector and the magic of market forces are somehow going provide for families.  They never have, and they never will.  That’s why we need a government, it’s time to make them do the job.

I didn’t put this on the top of the list, but our union represents home care workers, nursing home workers, developmentally disabled workers, and the government and society has depended on them for care as much as they do hospital workers, yet they are severely underpaid and under resourced.  Good health care is a top to bottom priority, and we have to guarantee our people that they will be provided for when in care, and when giving care.

Yes, people will finally learn to wash their hands better, but the virus ought to bring forward a host of changes that we desperately need and can no longer ignore.  The temptation by policy makers will be to fight the last war, rather than the next, by putting more respirators and masks into production.  Many of us will include different items in our “run for it” bags and storage closets for sure.  But we need to learn from this that there are fundamental changes that we have to make in protection and provision for our people, and we need to do it now.