Casey bill would raise pay for long term care workers

Nicholas Smith of Philadelphia is a direct support professional at a facility that cares for people with intellectual, developmental, and autism spectrum disabilities. He’s worked in the field for 25 years doing everything from administering medications, to assisting with grocery shopping, to helping people become more independent by learning new skills and abilities. 

“But it’s a struggle to stay because I don’t make a livable wage,” Smith told the U.S. Senate Special Committee on Aging at a recent hearing. “A lot of people are leaving this field to make more money. Other industries are offering more money while people want to stay in his field. They cannot make ends meet.” 

Smith described working 16-hour days to get overtime, but said as a single father it means trading family time for those hours. “There are so many recitals and functions and football games, and things that I just couldn’t go to because I was working,” he said in an interview with the Capital-Star. 

The long-term care workforce is facing a critical shortage of workers, Smith and other testifiers told the Senate panel, a position backed up by the Biden administration, which last month introduced a controversial set of new regulations intended to increase staffing levels and improve patient care in nursing homes.

The new staffing rule from the Centers for Medicare and Medicaid Services has faced fierce opposition from the industry and Republicans in Congress. It establishes for the first time national minimum staffing requirements for nursing homes that collect taxpayer money through Medicare- and Medicaid-funded services.

The staffing requirements will be phased in over the next two to five years, and CMS has made provisions to grant exemptions for care facilities in rural areas.

In a written statement, the administration said it believes that by improving working conditions and wages, improvements in the recruitment and retention of direct care workers will follow, enabling nursing staff to provide safer, higher quality care to all residents.

Last November, 15 Republican governors sent Biden a letter objecting to the new rule and arguing that the nursing home industry is facing a workforce crisis, particularly in rural areas. The governors predicted that minimum staffing levels would “force over 80% of facilities nationwide to hire more staff” and result in many of them closing.

CMS officials said they don’t expect the new rule to force any facilities to close, noting that some states have imposed even higher staffing level requirements with no resulting shutdowns.

The new rule has been two years in the making, and CMS has fielded more than 46,000 public comments on it from caregivers, residents, industry representatives and resident advocates.

But the new rule only applies to caregivers in nursing homes, and the federal government is limited in what it can do to raise caregivers’ pay outside the confines of nursing homes that receive Medicaid or Medicare funding. Many caregivers work for private companies or agencies. 

To that end, U.S. Sen. Bob Casey (D-Pa.) introduced legislation, along with Sen. Tim Kaine (D-Va.) and Sen. Tammy Baldwin (D-Wisc.), to improve compensation and benefits and support systems for caregivers. The Long-Term Care Workforce Support Act would improve pay for direct care professionals, and put into place strategies to increase the number of care professionals, to reduce the current shortage.

“So many factors contribute to high turnover and difficulty recruiting a long term care workforce that can meet the needs of older adults, people with disabilities and their families,” Casey said during the committee on aging hearing. He serves as the committee chairperson. “Turnover rates for direct care workforce are 40 to 60%. In 2022, the median wage for direct care workers was just above $15 an hour.”

A 2022 report from PHI, an advocacy organization for healthcare workers, found that caregivers earn a median wage of $15.43 an hour, and many live in poverty. 

“If we claim that their work, their work as caregivers is essential, we should accord them the status of a professional,” Casey said. “This comprehensive bill will make a generational investment in the workforce that will help us care for our loved ones who need support.”

Ranking aging committee member Sen. Mike Braun (R-Indiana) agreed that the shortage of long term care workers was expected to get worse, but questioned whether more legislation was necessary. 

“We need innovation at the state and local levels to meet this increased demand,” Braun said. “We don’t need, really, a lot more from the federal government in my opinion, simply because it’s doing a lot. It’s borrowing a lot of it from our future generations to do it.” 

He criticized the Biden administration proposed nursing home staffing minimums, saying it could be “counterproductive” if nursing homes could not meet the requirements and had to close. 

Smith told the Capital-Star that he loves the work he does, but rarely works only 40 hours a week, and when he does, he worries his paycheck won’t be enough to pay the bills. 

“Everybody in their family has somebody that knows somebody who knows a DSP; somebody who’s taking care of your loved ones, your mother, your father, your brothers, your sisters,” Smith said. “It’s an act of devotion.”

Iowa Capital Dispatch Deputy Editor Clark Kauffman contributed reporting