IT’S BEEN TWO LONG, arduous, and devastating years since Massachusetts, the country, and indeed the world, were thrown into a terrifying situation as the COVID-19 pandemic swept through our communities.  For nursing homes, the impact was especially severe as we came to understand that elders with underlying medical conditions, which describes most of our residents, were the most vulnerable population to this insidious disease.  And, because of the communal nature of facilities, coupled with the contagiousness of the disease, it moved swiftly throughout our buildings with dire results at the outset.

We now have perspective from the past two years of experience.  We know what works to protect our residents and staff, namely strong infection prevention protocols, ample PPE, timely testing, vaccines, and treatments.  Some things we can boast about, such as being a national leader in the vaccination rate of our staff.  Some things we can’t—we are currently ranked 30th in the nation for staffing levels for a state that’s considered the vanguard in health care.

Over the course of the pandemic, our 45,000 diverse front-line staff have worked tirelessly to provide their residents with hands-on personal care and vital companionship.  Approximately two-thirds of our direct care staff are people of color and 39 percent are new Americans, and most do not yet earn a living wage.  Despite the challenges and stressors of working in a nursing facility, particularly during the COVID-19 pandemic, the vast majority of our mission-driven workers have dedicated their professional lives providing for, and fiercely protecting, their residents.  We are honored by their commitment and cherish their dedication to serving the most frail and vulnerable members of our community.

In recognition of their commitment and with an awareness that the current Medicaid funding formula for nursing home care isn’t sufficient to pay staff what they deserve, lawmakers and the Baker administration provided significant and necessary one-time emergency funding, which led to a 15 percent wage gain for our deserving registered nurses and licensed practical nurses and 19 percent for certified nursing assistants.  These investments were not only justified, they also have been critical to retaining our dedicated staff.  But we still face a historic workforce shortage.  Currently there are 7,400 direct care job openings in the nursing home care sector, meaning one in five positions are vacant.

We now desperately need lawmakers and the Baker administration to continue to support our frontline staff and make these wage increases permanent by funding an investment of $238 million (half of which is reimbursed by the federal government).  Not only will this $238 million ensure that wages won’t need to be cut when one-time funding expires on June 30, it will also allow nursing facilities to hire 2000 additional caregivers.  That’s why we are launching the Respect and Protect Nursing Home Caregiver Wages campaign.  We must protect the progress we made.

Without this funding, we will erode the meaningful progress we have made toward moving our staff closer to a living wage and instead be forced to cut pay, which will further exacerbate our historic workforce crisis and put in jeopardy access to quality nursing home care.  Make no mistake—we, our communities, our residents, their families, and caregivers, will regret it.

Demand for nursing home care is projected to grow exponentially over the next 10 years due to a 20 percent rise in the 85-plus population and, as nursing homes continue to close, access to care will be further threatened.  It is therefore critical that we have sufficient frontline staff to provide these essential services today and in the future.

Already, most of the state’s nursing homes are denying new admissions from the community and hospitals due to staffing shortages, which is disrupting access to care for patients and their families across the Commonwealth.  That’s with current occupancy rates hovering around 80 percent, and we project the need for nursing home care will sharply increase over the next several months.  That will mean even more admission denials.

The simple truth is that our ability to invest in our workforce is indelibly tied to government funding because over two thirds –22,000–of our residents rely on the state’s Medicaid program, MassHealth, to pay for the cost of their care.  But MassHealth reimburses our members $25 less per person per day than what it actually costs to provide care.  It’s an enormous and unsustainable difference, particularly as nursing homes brace for an imminent cut of $100 million in Medicare funding.  Medicare funding is typically used to offset the Medicaid shortfall.

The way to address this crisis is for the Legislature and governor to approve and fund $238 million for the exclusive purpose of hiring and increasing pay for our direct care staff. This is critically necessary to ensure the safety, care, and wellbeing of our most vulnerable citizens.

We must respect and protect nursing home caregiver wages.  We simply cannot afford to go backwards.


Tara Gregorio is president of the Massachusetts Senior Care Association.