Short-Staffing, Lack of PPE, and Inconsistent Testing are Symptoms of Larger Structural Flaws, Urges Government, Industry and Labor Unity to Improve Care and Working Conditions
Los Angeles, CA — May 11, 2020 — The President of California’s largest labor union, joined by nursing home workers and elected leaders, offered a sobering assessment of the state’s nursing home industry as COVID-19 deaths in skilled nursing facilities continue to climb. Citing the need to triage the current crisis, address long-ignored structural flaws in the industry, and prepare for a battle against the virus that is expected to stretch on for the foreseeable future, the Union called for a series of reforms to improve care, working conditions, and staffing standards immediately and to modernize the State’s hobbled long term care system to absorb an elderly population that is expected to reach 9 million this decade.
In a video press conference, Union leaders and members detailed the current conditions facing nursing home workers, including the ongoing challenge to secure medical grade Personal Protective Equipment (PPE), lack of consistent and reliable testing, and unsafe staffing levels further destabilized by the crisis. Union leaders also outlined broad structural deficiencies in the nursing home industry that have exacerbated the Covid crisis including unintended consequences brought about by the new Medicare reimbursement methodology and an opaque, convoluted industry structure that shields owners from direct responsibility while allowing many operators to reap massive profits .
In 2018, Medi-cal and Medicare accounted for 70.5% of beds in facilities across the state of California. However, the higher Medicare payments provide financial incentives to get rid of Medi-Cal residents, thus leaving the poorest, most vulnerable residents at risk of being released prematurely. Complex ownership structures coupled with waivers on recently-upgraded staffing standards have allowed nursing homes to ignore reasonable staffing level requirements and keep wages disturbingly low, cheapening the quality of care for residents despite a highly profitable system.
“Long before COVID-19 began taking the lives of our most vulnerable, California’s nursing home industry was already in critical condition, with fundamental flaws on display,” said April Verrett, President of SEIU Local 2015, the state’s largest union representing 400,000 long term care workers, including 25% of the state’s nursing home workers. “In California, and throughout the country, nursing home executives have become experts at gaming the healthcare system to maximize profits while minimizing accountability, resulting in reckless cost cutting, gross understaffing, all while propelling profits forward, and leaving low paid workers and residents behind.”
The median annual earnings of nursing home workers is $23,000 with 10% of caregivers living in poverty and 53% living in low-income households. On average, licensed vocational nurses made $28.50 per hour, while certified nurse assistants made $15.65 per hour and laundry and linen workers made just $13.26 per hour. The nursing home industry’s workforce is predominantly women (81%), immigrants (54%), and people of color (86%). Between 2013 and 2020, under the State’s reimbursement system, increases in administrative payments outpaced investments in staffing by over three times (17.8% increase vs. 5.8% increase respectively), confirming the maximization of profits at the expense of residents’ care. Based on annual financial data the state releases, non-care specific expenses including payments to related parties, home office allocations and administrative expenses increased by 25%, 14% and 30% respectively between 2010 and 2016.
Furthermore, 90% of California’s nursing homes are privately owned, according to UC San Francisco professor emeritus Charlene Harrington, who studies skilled nursing facilities. Her research found that 75% of California facilities are owned by chains and those facilities that are owned by for-profit chains have lower staffing levels and more regulatory problems than non-profit facilities. From 2015 to 2019 ten of the largest administrations across the state of California collectively received 4,345 citations and or penalties. Nursing Home data on health deficiencies show that in their latest inspection prior to the pandemic, nearly 70% of California nursing homes did not have and were not implementing an infection prevention and control program. Since the onset of the pandemic there have been nearly 1,276 nursing home related deaths, making up 50% of fatalities across California, according to the latest data available from the state.
“The ongoing health crisis has made an already difficult situation worse because of the working conditions we have experienced for a long time,” said Lupe Martinez, SEIU Local 2015 member. “I am currently battling COVID-19 myself, a testament that we have been risking our health and are in the dark about just how bad the spread of the infection actually is. We’ve lacked PPE and we haven’t felt safe. We don’t make a lot of money and can’t afford to take off from work making us choose between our health and livelihood.”
SEIU Local 2015 is advocating for several immediate measures to support all long term care workers on the frontlines of this pandemic, including:
- Skilled nursing facilities must have a 14-day supply of medical-grade PPE on-hand for staff with ongoing procurement for non-state supply chains;
- Immediate testing of all nursing home workers and patients, and a standardized testing regime statewide going forward;
- Fully-funded, accessible healthcare for every worker, including paid sick leave and 100%-paid testing and treatment for COVID-19;
- Pandemic pay that reflects the essential nature of the work.
“Yes, we must continue to address immediate crisis needs. But, truth be told, in the early months of the year 2020, I was worried about a different looming disaster: the fast approaching “Silver Tsunami”,” said Verrett. “Any response in this moment must factor in both immediate and long term needs that account for the reality of the challenges facing our system including low pay, short staffing and profis placed over care. The magnitude of the long-term crisis requires essential care workers to have a seat at a statewide table with the industry, and to come together with the state and federal government and take immediate actions including:
- Evaluation and reconfiguration of the Medicare system which currently incentivises nursing home employers by rewarding higher payouts for short term patients, leaving long term patients with an even greater lack of quality care;
- Full transparency of corporate systems to ensure that profits contribute to higher quality of care and not executives’ bottom lines;
- Training for infectious control and a program that includes disaster preparedness with regular upskilling allowing for workers’ healthcare growth opportunities; as well as a recruitment program to fill current short-staffing and the future needs;
- Pay and benefits that demonstrate the value of nursing home workers not just in this moment, but moving forward and always;
- Further investment in recruitment and training of workers to meet the growing demands of the aging population.
By 2030, California’s population of individuals older than 65 is expected to increase by 73% from 5.2 million to 9 million, and it is estimated that California will need at least an additional 15,800 Certified Nursing Assistants by 2026. Low wages, lack of training and poor recruiting efforts have led to a labor shortage and a 50% turnover rate among current employees.
“The system has allowed ruthless profiteering on behalf of employers,” said Assemblyman Ian Calderon, 57th Assembly District. “This structure has allowed nursing homes to run a profit that is not being seen by its workers or residents, leaving holes in the caregiving of our most vulnerable population. It is vital that our nursing home workers and residents are given the protection and care that they deserve. We must act in this moment however, in this moment we must also take on larger problems that are corrupting the quality of care in the industry.”
“Nursing home structure has allowed owners to make a profit at the expense of care for too long,” said Assemblyman Ash Kalra, 27th Assembly District. “The lack of transparency in large nursing home chains has made it impossible to hold owners truly accountable for their mismanagement, allowing them to keep wages and staffing levels low, sacrificing both employees and care for residents. Measures must be taken to protect workers and protect at-risk residents.”
Union officials pointed to State-led initiatives already in motion as a potential path forward to reform the nursing home industry and the broader long term care sector.
“SEIU Local 2015 welcomes others to join us in our commitment to advocating for solutions that will protect nursing home patients and workers in both the short and long term,” said April Verrett, President of SEIU Local 2015. “We commend the leadership and foresight of Governor Gavin Newsom, for laying the groundwork for the Master Plan on Aging, more important now than ever before, as the elderly population in California continues to grow. A plan of this magnitude will require industry leaders, workers and their union, state and local governments to work together in the best interest of patients.”
Since the outbreak of COVID-19, SEIU Local 2015 members and leaders have continued to address the ongoing needs of people working on the frontlines of our healthcare system and have remained committed to calling on the administration to prioritize the nation’s essential long term care workers.
To learn more about SEIU Local 2015 visit www.SEIU2015.org or on social media @SEIU2015.