Nursing home industry sounds alarm – again

THE STATE’S NURSING home industry is again sounding the alarm, saying a package of nearly $560 million in state and federal aid is needed to address chronic staff shortages and financial instability that has shuttered 11 facilities and left 100 more at risk of closing in the next 12 months.

The Massachusetts Senior Care Association said 1 in every 5 nursing and direct care positions at nursing homes are currently unfilled. The association called it “the worst staffing crisis in history,” although last year’s numbers may have been even worse.

Nursing homes became the deadly epicenter of the COVID crisis in Massachusetts last year and pulled through with the help of infusions of state aid. Tara Gregorio, the president of the Senior Care Association, said the industry is facing continued challenges and needs additional state aid to stay afloat.

Gregorio laid out her industry’s plight at a State House hearing focused on what to do with the billions of dollars in federal aid the state has received. At the hearing, scores of officials from the human services sector said they were facing similar staff shortages and urged lawmakers to provide funding. The calls came from all corners, including addiction treatment providers, behavioral health services, the Greater Boston Food Bank, and backers of the local public health system that was described as “dangerously inadequate.”

Marylou Sudders, the secretary of health and human services, said the Baker administration used $55 million to provide a 10 percent wage rate increase for many health and human service providers. But she acknowledged that money would run out in December and a longer-term solution is needed. She said Gov. Charlie Baker would file legislation to address the problem.

“We have to invest in our workforce,” Sudders said.

Nursing homes in Massachusetts appear to be caught in a never-ending loop of financial uncertainty. In March 2019, Gregorio said 19 facilities had gone out of business in the prior year and 100 more were in danger of going under because of inadequate Medicaid rates. (Medicaid covers roughly 70 percent of nursing home residents.)

In April the following year, Gregorio wrote a letter to the state’s top political leaders warning that 2 of every 5 staffing positions at nursing homes are vacant because the employees have either contracted COVID-19, are quarantining due to exposure to it, “or they simply fear coming to work.” She said the state’s nursing homes need to hire about 17,000 people “to reach a basic staffing level.”

At the time, Gregorio warned of death and devastation if the state failed to ramp up COVID-19 testing of residents and employees, prioritize the delivery of personal protective equipment, and funnel an additional $130 million to the industry.

The state did come through with some additional emergency funding, and then announced a more formal funding package in September that provided $82 million a year in additional aid through the rejiggering of Medicaid rates. The funding provided an average 6 percent rate hike across the industry and an 8 percent average rate hike for high occupancy, high-Medicaid facilities.

To qualify for the funding, facilities had to meet minimum staffing levels by January 2021, guarantee that 75 percent of revenues go to staff by October 1, and begin eliminating units housing three to four people, shifting to singles and doubles, starting in October and finishing the job by January 2022.

Despite the funding package, Gregorio’s comments on Tuesday indicate the industry appears to be right back behind the eight ball. Gregorio on Tuesday asked for $98 million — $53 million of which would come from federal Medicaid matching funds – to pay wage increases to direct care staff, hire new employees, and fund infection control efforts.

Gregorio also asked for $285.5 million over the next three years to pay for $2,500 retention bonuses for 40,000 staff, scholarships, and a recruitment program for nurses from abroad. She also sought $150 million for infrastructure improvements, including the converting of multi-occupancy rooms into single occupancy rooms, the modernization of buildings, and the development of specialized care units. And she asked for $25 million for education and training for nursing home workers.

“This historic workforce shortage has left Massachusetts nursing facility with an urgent and immediate need to hire and retain direct care workers.  The vast majority of our staff are working overtime to ensure adequate care coverage for residents and over half of nursing facilities are intermittently denying new resident admissions,” Gregorio said in a statement.