Nursing homes have made staff gains, but more needed

Facilities still facing shortage of 4,000 direct care staff

MASSACHUSETTS NURSING facilities were at a crisis point regarding staffing even prior to the COVID-19 outbreak, due primarily to the inability to pay a competitive wage. In Massachusetts alone, there were an estimated 5,600 vacant direct care nursing positions pre-COVID-19. To address the ongoing urgent need to meet the care needs of the Commonwealth’s most vulnerable residents, the state must amend state law to provide competitive wages and a path to certified nursing assistant certification for frontline workers who stepped up to serve as nurse aides during the pandemic.

Over the last year, the state has been a crucial partner to long-term care facilities, working in partnership with nursing home leaders, the Massachusetts Senior Care Association, and the COVID-19 Policy Alliance at MIT to address longstanding staff vacancies. The state has provided meaningful wage increases to frontline staff, established the new position of resident care assistant, or RCA, to support the overall caregiving team in nursing facilities, and established an immediate career pathway for RCAs to become certified nursing assistants through newly implemented on-line training platforms. The state must allow the RCA position, and these newly implemented online training platforms and the clear career pathway they support, to continue post-pandemic in order to expand the long-term care workforce to meet the care needs of nursing facility residents.

Thanks to an increase in state support for nursing facilities during the pandemic, including the development and implementation of the new RCA position, Massachusetts nursing facilities have begun to expand the long-term care workforce to meet the care needs of older adults and individuals with disabilities living in Massachusetts nursing facilities. Thus far, 600 capable and responsible individuals have answered the Commonwealth’s call to help support our elders in the midst of the pandemic, by serving as RCAs.

After receiving training and demonstrating skills competency, RCAs have become an integral part of the care team and help to answer call bells, deliver meals, assist in dressing residents, bedmaking, assist with technology devices to connect residents with loved ones, and provide vital companionship. The dedication and commitment of the nursing facility caregivers, including RCAs, has been selfless and truly heroic throughout the pandemic.

The RCA position opened the door for individuals seeking a meaningful career change. During the pandemic, many RCAs who had previously held jobs in the retail, food service, and hospitality sectors that were greatly impacted by the pandemic began to work in senior care. Creating a career pathway for these assistants is key to successfully recruiting and retaining the staff that is much needed to work in long-term care.

For example, Legacy Lifecare created a career pathway for its newly hired RCAs by developing a state-approved certified nurse aid training program.  RCAs use asynchronous, online training to become certified nursing assistants, while also earning a competitive wage. Because the asynchronous online training model content is available 24/7 and self-paced, it allows students the flexibility to receive training at home, on their own time, juggling family life, and while they continued to work and earn necessary wages as RCAs. To date, Legacy Lifecare has offered free training to 13 RCAs who have successfully completed the program, and are awaiting their certification exam. After passing the certification exam, these RCAs will become certified nursing assistants, and help to fill the gap in the state’s much needed long term care workforce.

But, even after staffing up during the pandemic, Massachusetts nursing facilities still face a critical shortage of 4,000 direct care staff. The state can meet this shortfall post pandemic by funding a competitive living wage, by continuing to support the RCA position, and by making certified nursing assistant training widely accessible and affordable via online platforms and partnerships with our community colleges, vocational schools, and local training providers.  These simple strategies are necessary to ensure we have the caregivers needed to meet the needs of older adults today and in the future.

As nursing facilities make sustained progress in the fight against COVID-19, we urge government leaders to continue to make the necessary investments in our Medicaid and Medicare payment systems to fund wage increases for our deserving staff, while also adopting public policies and initiatives that meaningfully address a decade of workforce shortages in the Commonwealth’s nursing facilities.

Adam Berman is president and CEO of Legacy Lifecare, a not-for-profit provider of long-term care and other services for seniors and the disabled.  Kate Kellogg is the David J. McGrath Jr. professor of management and innovation and a professor of business administration at the MIT Sloan School of Management. Jenna Myers is a PhD student in organization studies at the MIT Sloan School of Management, and a volunteer at the Covid-19 Policy Alliance.