Austin American-Statesman: Doggett: It’s time to change the way we care for our country’s seniors

We need a federal staffing standard for nursing homes

For the millions of Americans who call our communities’ nursing homes home, each day is uncertain. A severe staffing crisis has resulted in inconsistent quality and quantity of care for nursing home residents.  

Because of short staffing, Certified Nursing Assistants (CNAs), who do the bulk of the hands-on caregiving, can be responsible for more than 20 residents — that means getting 20-plus residents out of bed, bathed and toileted, and dressed in time for breakfast each morning. It can also mean managing emergencies – like a resident falling or getting sick – with little no to additional support. Nursing home workers must make impossible decisions every day.

The pandemic laid bare the deep cracks in our nation’s long-term care system, especially when it comes to staffing. To repair these cracks, we must first tackle the devastating healthcare workforce crisis. 

We hear a lot about a “worker shortage” but the truth is, there is a “good jobs” shortage. Despite the essential work they do caring for our loved ones, nursing home workers are struggling to care for themselves and their families. The physical and emotional toll on caregivers caused by short staffing, combined with low wages and lack of benefits, has resulted in a significant exodus of long-term care workers from the industry. 

Currently, the median turnover rate among CNAs is nearly 100 percent. Those who remain are burning out, exhausted by constantly working short staffed.

Compassionate, skilled caregivers leave the industry for better paying, less demanding jobs. Nationally, the median hourly wage for a CNA is $14.41. No matter where you are in the country, $14 an hour is not enough to live on. And it’s not nearly enough to reflect the value of this work. It’s also important to note that most for-profit nursing home corporations remained profitable throughout the pandemic, a strong indication that they can, in fact, offer better wages.

We can’t afford to lose any more caregivers. The jobs needed to support members of our communities of any age who have disabilities, or provide compassionate home care services for our aging parents and grandparents must be good union jobs with family-sustaining wages and benefits. As the demand for care grows, so does the demand for qualified, professional caregivers. Investing in care and providing a path to citizenship for immigrant workers can help meet that demand.

With the highest number of ranches and farms in the country, Texas is a very rural state. In communities across Texas, hospitals and clinics are further away, and it takes much longer for emergency services to reach a client’s home. Grocery stores and pharmacies aren’t easy to get to — be it distance or mobility issues — so seniors and people with disabilities are more susceptible to running out of vital supplies like dish soap, paper towels, toilet paper, or over the counter medications. Cell service and internet access can be unreliable.

Because of these disparities, the need for safe, quality nursing home care is more important than ever in our rural communities. A disproportionate number of people in rural communities are over the age of 65 — seventeen percent of the population, as compared to 13.8 percent in urban areas. And nearly one in four rural seniors lives alone. With fewer resources and lack of nearby families to assist with and coordinate care, many of these individuals will rely on nursing home settings both for long-term care, as well as rehabilitation services after surgery and accidents.

This past March, my colleague Rep. Jan Schakowsky (IL) and I led a majority of the House Democratic Caucus in urging the Centers for Medicare & Medicaid Services (CMS) to establish robust nursing home staffing standards. In a letter sent to CMS Administrator Brooks-LaSure, my colleagues and I noted that it has been more than 20 years since CMS reviewed the number of care hours a nursing home resident should receive. In that review, CMS found that nursing home residents require 4.1 hours of direct nursing care spread across different roles (e.g., registered nurses, certified nursing assistants). Despite these crucial data, CMS did not issue a mandatory standard for care hours, leaving the states to decide. It’s time to do so now. 

With a federal staffing standard, nursing homes will become safe and vibrant communities, where residents can thrive and workers can go home after each shift knowing their residents received the quality care they deserve. 

Doggett, D-Austin, represents District 37 in the U.S. House of Representatives