Tara Gregorio has had a busy first year.

Since coming on to the Massachusetts Senior Care Association as its president in January, she has had to grapple with leading an organization representing approximately 400 nursing facilities and assisted living residences, caring for some of the most vulnerable people in the state.

Of those facilities, stagnant reimbursements mean approximately half are operating in the red. The organization said 180 are at risk of closing, taking with them more than 25,000 jobs.

What’s more, the industry has a number of vacant jobs, and the association is trying to achieve a $15 minimum wage for its workers to fill them.

The organization has had some recent success, with the Legislature providing a $7.5 million increase in Medicaid nursing home funding in the fiscal 2018 budget, which Gov. Charlie Baker had initially vetoed. The organization has even seen increases in recent years, receiving a $35 million bump in the fiscal 2017 and fiscal 2018 budgets to go directly to wages. But for Gregorio, the fight is far from over.

Gregorio sat down with reporter Jessica Bartlett to talk about her work with the organization, and why her second year in the role will be just as busy as her first.

Why are nursing homes and senior care facilities struggling so much? The government reimbursement, particularly state and Medicaid, hasn’t kept up with the cost of providing quality care. For the past decade and a half, (the state has) been level-funding (nursing homes). Currently, Medicaid pays $37 a day, per-resident below what it costs for care. And Medicaid pays for the care of 70 percent of our residents.

Why do so many patients need Medicaid? Don’t many qualify for federally-funded Medicare because of their age? Medicare does not pay for long-term care, they only pay for medical rehab services.

What is at risk without more funding? We’re concerned nursing facilities are on the brink of bankruptcy and possible closure. In some cases, its entirely appropriate for nursing facilities to close … we’d work with the administration to think of a thoughtful closure plan. But to starve all facilities won’t have the positive outcomes we all want.

Why is it appropriate for some to close? We know there are 6,000 empty beds, according to the Department of Public Health. There is capacity … (but) we want it to be a thoughtful closure.

Despite excess capacity, your organization is looking for more people to work in the industry. (We did) a wage and benefit survey to our members. What we saw this year is the number of vacancies in the certified nursing assistant position — who are helping grandma move, eat — (in 2015) it was one in 10. Now it’s one in 7 positions for 2016. In some parts of the states it’s 1 in 5 – a 20 percent vacancy rate. And that has an impact on quality, and we’re seeing that with deficiencies. But for the patient it means when they hit the call button…they are having to wait longer for it to be answered.

You had filed two bills with the Legislature and only saw partial success. What did the Nursing Home Stabilization bill envision? In order for us to recruit and invest in staff and update our physical plant, there needs to be a $200M investment over time. The first phase is update our rates to more current costs, because currently our rates are based on 2007 costs. If we update to what we’re saying is 2014, then that would cost approximately $80 million … Then moving forward, rates should increase annually using the same inflation factor Medicare uses for nursing homes, doctors, etc. That would, if we assume inflation to be 2 percent, that’s a $36 million increase in spending annually. From there, we talk about we also need to recruit and establish scholarship programs so our workers can move forward and advance their careers by attending community college or universities to become LPNs or RNs or social workers to support the workforce.

You also filed a Quality Jobs for Quality Care bill asking for $90 million this year specifically for wages, correct? The Legislature has responded in previous years, but not at the level of $90 million. But we’re telling the Legislature that this is a crisis point.

Despite these bills, the Legislature gave you $35 million for wages and $7.5 million toward either the wage bill or stabilization initiative. What does that mean for nursing homes in the year ahead? While we are appreciative of the state’s commitment to maintain funding … the lack of additional funding in the current fiscal year for direct care staff means it will be virtually impossible for the nursing home provider community to continue to make critically needed investments in our frontline staff, since a facility’s ability to invest in staff and quality of care is dependent upon state funding. We are extremely concerned that without significant relief, we will see nursing facilities close or file for bankruptcy. All the signs of a financial crisis are there.

What are the organization’s advocacy plans for the year ahead given these concerns? We plan to continue to work with nursing home residents, their families and staff to aggressively advocate for passage of both (bills for future funding).