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Scapegoating senior care helps no one

Understand the nuances behind the issues to advocate for our seniors and careforce. Learn the facts behind the sensational headlines below.

Fallacies vs. Facts

A December 2022 USA Today article relies on hyperbole and cherry-picked facts to paint a bleak picture of the senior care industry. Discover the full truth as we dissect the fallacies versus facts.

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“U.S. facilities fell short of multiple benchmarks the federal government has created for nurse and aide staffing.”

Fact

The senior care sector is facing a historic staffing crunch. More startling is the report’s finding that the long-term care industry will need to fill 7.9 million jobs in direct care over the next decade, when accounting for both new jobs and job openings created by people leaving the direct care field or the labor force altogether.

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“Low-income residents, disproportionately people of color, fare the worst.”

Fact

Nursing homes are reflective of the communities where they are located. Disparities in healthcare are directly related to those communities’ residents having access to insurance, healthcare, and health literacy. Ongoing disadvantages for the poor and racial and ethnic minorities have deep historical and cultural roots and are by no way caused by the senior care industry. Workers who live and work in low-income communities should be commended for their efforts versus blaming them for the social structure of our society.

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“Their nursing homes report the lowest staffing levels, but data show they seldom get in trouble because of it.”

Fact

Nursing homes in underserved communities are overwhelmingly financed by Medicaid, which chronically pays below the cost of care. In addition, Medicaid enrollees tend to have more chronic health conditions at a higher level of acuity than the general population, meaning they need more intensive care.

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“Having enough nurses and aides is the strongest predictor of whether nursing home residents will thrive, researchers have found.”

Fact

Prior to COVID-19, nursing homes were already in search of more workers. The pandemic caused the loss of another 200,000 workers, adding strain to those who stayed behind. This significant loss of workforce is the accelerant fueling an exodus of staff to other labor sectors. This crisis will only get worse as the aging United States population is expected to need another 2.5 million long-term care workers in the next seven years. The senior care industry has told Congress and the White House repeatedly that the nation’s interconnected healthcare system is facing unprecedented challenges. Negative stories aimed at weaponizing public opinion against nursing homes are a convenient scapegoat for policymakers to avoid addressing the chronic neglect of the healthcare sector. In reality, with the overwhelming majority of financing in the sector coming from state and federal sources, it is clear that policymakers have made deliberate decisions to undermine senior care for decades.

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“In its wake, former certified nurse assistant Tracey Pompey is floored that the public has not demanded better care for vulnerable elders.”

Fact

The public’s response should not be a surprise given the decades-long push to demonize the nursing home industry so that Medicaid underfunding could continue, freeing up dollars for other political priorities. Ageism also plays a role, as our perceptions of nursing homes are directly tied to our personal feelings about growing old, death, and the value of the elderly and disabled in our society. The majority of Americans have little direct experience with the senior care industry until they have a loved one who needs care — what knowledge they do have comes mostly from negative stories that represent the exception, not the majority, of senior care communities and care workers.

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“Taxpayers spend nearly $90 billion each year on Medicaid and Medicare stays at nursing homes—many of them run by companies that report double-digit profit margins.”

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“Half of nursing staff—or more—turns over in a year, according to federal statistics on the industry.”

Fact

“Too often, poor job quality in this sector is shaped and reinforced greatly by limited government funding and inadequate reimbursement rates under Medicaid. Home care agencies, residential care settings, and nursing homes that rely on public funding to deliver services regularly report not being able to make substantive improvements in compensation, training, career advancement, and other aspects of the direct care job without more public funding. For this reason, measures that increase wages for these workers should come with additional funding for employers to avoid further straining this sector and decreasing its services.” – PHI National

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“Somehow, somebody is making money off of this and it certainly isn’t the caregivers. I’m tired to my soul.”

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“Halamandaris said the 1967 Moss Amendments, among other things, were intended to lead to the creation of staffing minimums and a subsequent crackdown.”

Fact

As David Grabowski, Harvard Medical School professor of health care policy who studies nursing homes, notes, “The expedited improve-or-terminate process could end up hurting access to care for low-income Medicaid beneficiaries who typically make up the bulk of residents in low-quality facilities.”

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“That 'expected' level of staffing, which USA TODAY used in its analysis, is almost always lower than the 2001 minimums.”

Fact

The expected level of staffing does not yet exist in the United States. While hospitals lost 32,900 employees between December 2020 and December 2021, SNFs lost more than 145,000 workers, and LTC as a sector has lost more than 400,000 employees since the start of the pandemic.

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“Based on the 2001 federal study, the home should have enough aides to provide 2.8 hours of care per resident each day.”

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“The federal manual given to states to train their inspectors for years told them they should not investigate staffing levels unless the inspector had first found that care standards were not met. It’s like handing out speeding tickets only to drivers who crash.”

Fact

The article clearly states that inspectors found that “care standards were being met,” yet it infers that additional steps should be taken to punish care providers who are meeting the needs of their residents. Those who provide care and those who oversee care have the same goals for the people they serve. Encouraging an adversarial relationship between government and nursing home providers does not result in better care and, in this context, continues to reinforce the trope that nursing homes are inherently bad.

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“‘A year later when you went back, they would have slipped back into their bad practices,’ he said. ‘There still wasn’t enough CNAs. Wasn’t enough licensed nurses.’”

Fact

The senior care industry has been demanding common-sense approaches to addressing the number of certified nursing aides and licensed nurses. Delays in testing and a lack of available testing sites for temporary nursing aides risks the loss of thousands of workers that were hired during the pandemic when the Public Health Emergency (PHE) ends. Waivers to allow these workers to continue working an additional 24 months following the end of the PHE would solve this issue and count toward their training hours. In addition, if Congress would pass the Healthcare Workforce Resilience Act they could increase the number of available nurses by recapturing unused worker visas from previous years, allowing for more nurses and doctors abroad to work in the United States.

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“Researchers have connected the disparity in staffing to higher for-profit ownership of nursing homes in Black communities and the fact that more Black residents pay for their stays with Medicaid, which reimburses nursing homes at a lower rate.”

Fact

For every dollar that a nursing center spends on caring for a Medicaid patient, state Medicaid programs only reimburse the nursing center, on average, approximately 89 cents (according to AHCA). The deliberate choice on the part of policymakers not to cover care costs has a disproportionate impact on Medicaid residents, who are predominantly people of color and Americans from underserved communities. The availability of staff in those areas with high Medicaid-census suffers as a result.

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Join the Conversation.

Blaming senior care communities without acknowledging the lack of proper federal funding paints an inaccurate picture of the industry. Our heroes deserve better. Shine a light on your courageous team members, and tell us the challenges you continue to face in your community.

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