Politicians bleat about “our loved ones” who suffered through this year of isolation, as nursing homes segued into death wards. So, post-COVID, we want to make the Biblical Commandment real: we want to honor our elders. The frail, the sick, the dependent - all need more nursing home staff, more home care staff, better trained staff, more protections for staff. We want to translate that angst into numbers.
But those behind Exodus did not grasp the economics of caring.
And post-COVID, we are watching the angst fade as the projected costs mount.
The clarion cry in state legislatures is to beef up care, not just in nursing homes but home care also. “Our loved ones” need help with bathing, feeding, toileting, medications, walking - and they need the sociability of living in a community, whether it is a nursing home, assisted living, or their own homes. COVID laid bare the weak staffing in many nursing homes, exacerbated by the virulent virus that sent staff into weeks of quarantine. COVID also laid bare states’ reliance on nursing homes over home-based care: people living with caregivers (paid and family) managed far better through COVID than their counterparts trapped in nursing homes, unable to leave, unable to have visitors.
The solution seems simple.
Mandate more staff hours per resident. Staff complain they are overworked; the solution: more staff.
Spend more money on home care. Post-COVID, people will be eager to stay home if they can. States can both reallocate money spent on residential care, and increase the home-care budget.
Staff turnover is frightening, giving residents little chance to form friendships with staff. But turnover reflects salaries: nursing assistants, earning a median of $29,640, had a turnover rate of 27% a year, compared to 16% for registered nurses, who earned $73,300.
The solution: make salaries match the rhetoric. If we consider these people so crucial to “our loved ones,” pay accordingly, at least more than the restaurants and stores that are wooing workers. Include insurance, sick time, vacations, maybe even pensions and a chance for advancement. (As many as one sixth of nursing assistants have no health insurance.)
But in this season of federal largesse, let’s watch how legislators react to the bills before them. In Rhode Island, advocates are proposing a $15 an hour minimum wage — hardly extravagant, given the six-figure salaries of the directors of those organizations, even the non-profit ones. New York State legislators are considering a Fair Pay for Home Care Act that would raise salaries to at least $35,000 a year. New York’s governor is trying to cap executive salaries and facility profits. Gov. Gretchen Whitmer (D) in Michigan wants to raise salaries by $2 an hour; the GOP contingent in the legislature objects. Union officials in Connecticut want a $20 an hour floor, plus guarantees of more staff. Arkansas legislators are wrangling over a bill, supported by the industry, that would expand the categories of workers counted as direct care, in staffing ratios. In other states, similar discussions rage.
The dilemma persists: Any improvements will cost money. And money in this industry has not been lavished on front-line staff. The “industry” is sending its well-paid lobbyists - the ones who stuff candidates’ coffers — forth: the modest changes are too expensive, too hard, too impractical. The negotiations will start. Can we agree on $14 an hour? How many hours per resident can we shave? How many dollars can we funnel from nursing homes to home care?
State legislators are caught in a bind. On the one hand, the relatives of “the loved ones” want better care. And if those relatives are on the cusp of needing care themselves, that concern is strong. On the other hand, the budget-crunchers fear that boosts in spending will boost taxes, which will anger taxpayers. (If states compensate by cutting other services, that too will anger taxpayers). In the background are the industry honchos who must decide: How can we minimize costs, keep profits up? The large for-profit industry “leaders” may threaten to drop nursing homes and re-deploy fungible capital into something else, maybe trailer parks.
The “loved ones” have no loud voice in these negotiations. They wait to see how their legislators cost out love.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, June 15, 2021
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