Why we must care for our caregivers and address the nursing home staffing crisis

As the country tries to put COVID-19 in the rearview mirror, the 1.4 million nursing home workers who cared for our loved ones through the depth of the pandemic are seeing things get worse, not better, both for them and for the residents they love. Profit-driven nursing home ownership and decades of regulatory neglect, coupled with the pandemic’s fallout, have left skilled nursing facilities in dire crisis. 

Certified Nursing Assistants (CNAs) do the bulk of the hands-on caregiving. Over the last three years, it’s been common for the number of residents they have to care for on a single shift to go from 15 to 20 to sometimes 50. Burnout, low wages, and lack of training and support has led to a nearly 100 percent median turnover rate among CNAs in nursing homes, worsening an already-dire low staffing crisis. 

Nursing home workers with SEIU, united in their unions, have sounded the alarm on the crisis for years, and they are being heard. Last year, President Biden announced that the Center for Medicare and Medicaid Services (CMS) would begin a year-long study and propose new mandatory minimum staffing standards to keep residents safe, improve care, and ensure workers are not overburdened. The announcement inspired hope for those who live in, have loved ones in, and work in nursing homes. It’s especially important for facilities with higher numbers of Medicaid beds, which tend to have both lower staffing levels and higher numbers of Black residents.

Yet some in the nursing home industry are trying to stop safe staffing standards, claiming falsely that minimum standards would worsen racial equity for those in need of nursing home care — the exact opposite of what would really happen.

The connection between staffing levels, safety and quality of care is well established, and current low staffing rates contribute to racial health disparities for nursing home residents. For instance, of homes where Medicaid pays for more than 71 percent of beds, nearly half (49 percent) have low staffing levels. About 21 percent of the residents in these homes are Black, well above the 13 percent average for all homes. A 2022 analysis details how lower staffing rates in Medicaid-funded facilities contribute to racial health disparities. 

The problem is also growing. Evidence shows how disparities in CNA staffing levels have widened in the past few decades, wherein staffing levels have improved in homes with fewer minority residents and plummeted in homes with more Black and brown residents.

Notably, facilities with low staffing and high Medicaid beds are also more likely to be for-profit (84 percent compared to 74 percent for all homes), and most for-profit nursing home corporations remained profitable throughout the pandemic, even when faced with high rates of COVID-19.  Many private equity and for-profit nursing homes frequently use “convoluted corporate structures” to obscure their wealth.

So while many of these nursing homes continue to claim they cannot afford to raise wages to increase staffing, there is plenty of evidence to show they can.

As caregivers watched their beloved residents die, feared for their own safety, worked overtime, and experienced trauma and grief that has endured, many were offered just pennies in wage increases. Low wages, insufficient staffing, and a lack of respect create unsafe jobs that no one wants to keep. It’s even worse in nursing homes where workers do not have their union to demand better standards. It is no wonder we are in a crisis.

What’s more, this crisis is rooted in the systemic racism of our care infrastructure. More than half of CNAs are people of color, and 90 percent are women. Yet despite nursing homes receiving billions of dollars from the Provider Relief Fund and other COVID-19 funding, real wages for CNAs actually declined from 2020 to 2021, a blatant example of how employers have long dismissed this workforce.

It is no wonder we are in a crisis.

With our nation’s senior population expected to nearly double in the coming decades, we must take action to solve this crisis and create a sustainable, quality long-term care system for all people in our country. A robust staffing standard will begin to address the current disparities in care, improve the quality of jobs, and help resolve current workforce shortages that harm workers and residents alike.

Steven Horsford represents Nevada’s 4th District and is chair of the Congressional Black Caucus. Mary Kay Henry International President of SEIU.