Overworked and Underpaid: Nursing home workers need legislative support

Eleven months into the pandemic, nursing home workers continue to bear much of the burden of Rhode Island’s front lines without much to show for it. In a field dominated by women of color, caretakers, RNs and CNAs make less than other healthcare workers for more work. On top of that, nursing homes have been ground zero for COVID infections, with residents making up the bulk of the deaths. The pandemic merely exposed the inherent issue in the state’s nursing care system.

“Nursing homes put up signs saying nursing home workers are heroes,” says Adanjesus Marin, spokesperson for Raise the Bar on Resident Care. “But they’re not being treated as heroes, they’re being treated as expendable.”

Raise the Bar is a coalition of various community and advocacy groups working together to lobby for a minimum staffing hours bill and wage hikes for nursing home workers. It started prior to the pandemic in 2019 with the goal of passing a bill through the state legislature and raising awareness of low wages, high turnover and higher workloads. It passed the Senate in the 2020 session, but got nowhere in the House.

This year the bill is back. It mandates 4.1 hours of staffed care for each nursing home resident, a number pulled directly from federal government guidance. “It’s important to keep in mind, nursing homes operate 24 hours a day,” says Marin. “If you were to think about the amount of care a loved one needs in a nursing home … they might need assistance feeding themselves for three meals a day, bathing themselves, social activities, the human interaction that people need.”

It adds up quickly, and Rhode Island ranks 41st in a national ranking of nursing home staffing hours by the Long Term Care Community Coalition with 3.19 average total staffing hours. Alaska tops the same ranking with 5.63.

“There are thousands of people every year who become CNAs,” says Marin. Most new CNAs entering the field of nursing home care will leave within the first three months. The reason? Low pay, high workloads. The average nursing assistant starting in a facility is $12.34 an hour, barely a dollar higher than the current minimum wage. In Massachusetts, just a 10-minute drive away from the Providence metro area, the minimum wage for nursing home workers is a dollar higher. In Connecticut, the minimum wage is well on its way to $15.

Today’s nursing home workers face bigger workloads than in years past. Ten years ago, the state government (not via legislation) promulgated rules mandating minimum staffing hours for nursing homes, but then repealed them. Back then a worker could expect to have to take care of around eight residents per shift. In 2021, that number is between 13 and 16 residents. Additionally, because of low wages, most nursing home workers work in multiple facilities to make ends meet, typically working eight hours at one home, before working a second shift at another. “That’s going to impact on best practices for infection control,” says Marin.

There’s no accurate count for the number of nursing home workers who have gotten sick from COVID or died. Anecdotal data from SEIU1199 says they’ve seen hundreds of workers get sick, and at least three from the union have died from COVID complications. But it’s not just nursing home workers getting sick. “We’re hearing over and over again about their families getting sick,” says Marin.

Nursing home workers are frequently invisible, despite the Ocean State’s growing elderly population. “Right around 80% of nursing home workers are women of color,” says Marin. “If that wasn’t the case, there’s no question in my mind that the state and these nursing homes owners would feel they couldn’t get away with paying so little wages and expecting people to do more and more and more work.”

Senate Bill #2 is the current nursing home staffing bill before the General Assembly, sponsored by Maryellen Goodwin and a host of others. It’s on track to pass the Senate again, with a full floor vote occurring after this issue goes to press. The bill would mandate nursing homes reach that federal guidance of 4.1 hours of staffing per resident, under penalty of monetary fines. The act would additionally mandate wage increases indexed to inflation. It also provides $600,000 for training nursing home workers in new best practices as they arise. Currently, there is very little professional development or training offered for workers. 

The road getting through the RI House of Representatives remains unclear. Its primary sponsor is Scott Slater, and it’s currently in the House finance committee with no committee hearing or vote scheduled. The bill passed the Senate in the last session before dying quietly in the House. A new Speaker came to power while we’re still living through the same devastating pandemic. Time will tell if the new boss is the same as the old.