Tag Archives for AHCA

Pandemic Lessons: “Essential Caregivers Act” Can’t Wait. A Merciful, Bipartisan Bill for a Voiceless Population

Published in RINewsToday on January 19, 2026

As COVID-19 spread rapidly across the country in March 2020—entering nursing homes largely through community transmission and staff movement—the Centers for Medicare & Medicaid Services (CMS) issued guidance calling for nationwide visitor bans in nursing homes. These strict restrictions barred all visitors and non-essential health care personnel, with limited exceptions for hospice care.

According to March 29, 2025 article, “Changes in Federal and State Policies on Visitation Restrictions in Nursing Homes During the COVID-19 Pandemic,” published in the Journal of Applied Gerontology, 31 states enacted statewide indoor visitation bans through executive orders between March 9 and April 6, 2020, and the end dates were between 6/15/2020 and 3/24/2021. CMS would later relax its guidance, permitting indoor visitation when facilities reported no new COVID-19 cases for 14 days and community positivity rates were low.

Charlie Galligan, a licensed criminal defense investigator in Rhode Island, knows firsthand the toll those restrictions took. He and his wife, Kerry, provided daily care for his parents for 13 years—his father, Jack, who died from Alzheimer’s disease in 2022, and his mother, Audrey, who lives with a traumatic brain injury. Balancing work with caregiving became the catalyst that pushed Galligan to lobby Congress to prevent the prolonged and unnecessary isolation of nursing home residents during future pandemics, including advocating for policies that allow designated family caregivers to visit.

“Long-term care lockdowns continued well after humane safety measures were established and family caregivers had been vaccinated,” Galligan claimed, noting that countless residents died alone as a result. “Daughters were forced to say goodbye to mothers with Alzheimer’s over FaceTime—often staring at their phones as exhausted staff struggled to provide even minimal connection.”

A Legislative Effort Revisited

The initial legislative proposal—the Essential Caregivers Act (H.R. 3733)—was introduced in June 2021 to reaffirm and enforce the right of nursing home residents to receive visits from family and friends during declared emergencies. When that proposal stalled due to the absence of a Senate companion bill, a second attempt followed the next year with the introduction of S. 4280/ H.R. 8331.  Political insiders say that these bills stalled due to the legislative process, timing, and competing priorities not because Congress rejected the process. Most recently, the Essential Caregivers Act of 2025 was reintroduced last month.

On Dec. 16, 2025, U.S. Senator Richard Blumenthal (D-CT) and U.S. Representative Claudia Tenney (R-NY) introduced bipartisan legislation in their respective chambers to prevent a repeat of the prolonged isolation and reduced care nursing home residents faced during the COVID-19 pandemic. U.S. Senator John Cornyn (R-TX) and U.S. Representative John B. Larson (D-CT) joined them in cosponsoring the Essential Caregivers Act.

The Senate bill, S. 3492, currently with seven cosponsors, was referred to the Senate Finance Committee. That same day, the companion measure, H.R. 6766, with 35 cosponsors, was introduced in the House and referred to the Ways and Means Committee and the Energy and Commerce Committee.

“Our movement to enact the Essential Caregivers Act is not led by professionals or lobbyists,” Galligan said. “We are simply a determined group of family caregivers—primarily brilliant, tenacious women from across the country, and one token guy from Rhode Island—who love our mothers and fathers and refuse to accept silence and separation as acceptable standards of care.”

Congressional Supporters Call for Passage

“During the COVID-19 pandemic, we experienced how dangerous and inhumane it is to isolate seniors and vulnerable patients from the people who care for them the most, say Rep. Tenney, in a statement announcing the introduction of the bill.  “Families were locked out, residents declined rapidly, and farm to many suffered alone,” she said.

“The Essential Caregivers Act ensures that this never happens again,” says Rep. Tenney, noting that they are loved ones, not visitors.  “They are caregivers, advocates, and lifelines. This bipartisan legislation protects dignity, safeguards patient rights, and makes sure compassion and comment sense guide our response during an future emergency,” she adds.

Sen. Blumenthal emphasized the bill’s bipartisan intent. “By allowing at least one designated essential caregiver to have safe, in-person access to their loved ones during an emergency, our legislation ensures that residents will never again face the devastating isolation experienced by so many during COVID-19,” he said.

Rhode Island Sen. Jack Reed, a cosponsor of the Senate bill, echoed that sentiment. “We want to keep people safe from germs, but we also want to keep them connected—because isolation can take a real toll on health,” Reed said. “Essential Caregivers Act would ensure that even during limited visitation, residents can still have in-person contact with a loved one.”

Sen. Sheldon Whitehouse has expressed support and is on a waiting list to cosponsor it – cosponsors are being added in bipartisan pairs. “Loneliness can take a real toll on residents of long-term care facilities,” he said. “This legislation recognizes the critical role loved ones play in supporting residents’ well-being, even during public health emergencies.”

Not yet committed to cosponsoring are Rhode Island’s two Representatives

At press time, Rep. Gabe Amo, had not yet committed to cosponsoring the bill. “I am reviewing the Essential Caregivers Act of 2025,” Amo said. “Family caregivers are the backbone of our long-term care system, and I remain committed to advancing policies that support patients, caregivers, families, and health care providers.”

Like his House colleague, Rep. Seth Magaziner (D-RI), has not yet committed to sponsoring the bill. Magaziner acknowledges the importance of allowing nursing home residents access to their loved ones and is open to considering the legislation. However, he is also working to understand what safeguards would be in place to ensure resident safety during emergencies, according to Noah Boucher, the lawmaker’s communications director.

The Nuts and Bolts

Recognizing that family members are essential to residents’ care and well-being, S. 3492 and H.R. 6766 aim to prevent the emotional, psychological, and physical harm caused by prolonged separation during public health emergencies.  This bill strikes a balance protecting public health while safeguarding the wellness of residents.

The Essential Caregivers Act requires nursing facilities receiving Medicare or Medicaid funding to participate. It guarantees that at least one designated essential caregiver may access a resident during periods of restricted visitation, provided the caregiver follows the same safety protocols as facility staff. If a resident is unable to designate a caregiver, a representative may do so on the resident’s behalf.

The legislation also affirms caregivers’ rights to advocate for residents, participate in care planning, and ensure residents’ civil rights are protected. Additional provisions address roommate rights, as well as exemptions for end-of-life and compassionate care.

Facilities must provide written justification if caregiver access is denied, with appeals overseen by state survey agencies.

The bill has been endorsed by the AARP and Consumer Voice.

Rhode Island Advocates Call for Passage

Calling for passage of the legislation, Rhode Island Long-Term Care Ombudsman Lori Light said the COVID-19 pandemic made painfully clear how critical family caregivers are to residents’ health, safety, and well-being.

“During extended lockdowns, we witnessed firsthand the profound impact isolation had on residents, including increased depression, anxiety, cognitive decline, weight loss, and loss of engagement in daily life. For many residents, family members are not simply visitors—they are essential partners in care – they provide emotional support, help residents communicate their needs, notice subtle changes in medical conditions, and advocate when something doesn’t seem right. When access was cut off, residents lost a vital layer of protection and connection. The lessons we learned during COVID-19 must guide future policy decisions,” Light said. “No resident should ever again experience prolonged isolation from the people who know them best,” said Light.

According to Deb Burton, MS, executive director of RI Elder, the isolation imposed on long-term care residents during the pandemic was devastating. While infection control was essential, she said, the complete separation of residents from their families caused profound and lasting harm. Burton, a gerontologist, noted that residents experienced rapid physical, cognitive, and emotional decline.

“Families endured anguish knowing their loved ones were frightened, confused, and alone during the most vulnerable moments of their lives. Family members are not simply visitors—they truly are essential caregivers. They provide a familiar face, a steady hand to hold, and an understanding of a resident’s routines, preferences, and communication needs. This is especially true for individuals living with dementia or other forms of memory loss, for whom familiarity and connection are critical to well-being and safety,” Burton said.

Comments from the American Health Care Association 

While expressing support for family involvement, the nursing home industry has raised concerns about certain provisions of the bill.

From Holly Harmon, senior vice president of quality, regulatory, and clinical services at the American Health Care Association: “While we wholeheartedly support family members taking an active role in their loved one’s care, there are certain provisions of this bill where we have concerns. Mainly, we believe each situation, including public health emergencies, requires a collaborative process among public health officials and stakeholders to determine the most appropriate way to keep residents safe and loved ones connected, rather than implementing a blanket, inflexible process for all situations. We hope to work with lawmakers to make improvements to these proposals as the engagement of loved ones is critical to our residents’ wellbeing.

“Despite our caregivers doing everything they could to step in for family members during the pandemic, we were deeply concerned about the prolonged isolation of our residents. Public health officials were put between a rock and a hard place on how to best protect those in long term care, and due to the vicious nature of the virus on our resident population, it was determined best to restrict visitors and social interactions. Nursing homes were required to follow these restrictions until March 2021, and even then, CMS and CDC had strict guidelines due to the ongoing spread of the virus.

“The best way to prevent this global tragedy again is for officials to prioritize long term care residents and staff during public health emergencies, so that they can remain protected, active, and engaged with their loved ones and the community.”

A Final Note…

The best way to prevent another tragedy is to prioritize long-term care residents and staff during public health emergencies, so they can remain protected, active, and connected to loved ones. We must learn from the painful lessons of COVID-19. No one should be forced to decline alone, grieve alone, or die alone because of a lack of clear policy, RIElder’s Burton added. She noted that the Essential Caregivers Act ensures that in the next public health emergency” when it could be any one of us in a facility” we will not be separated from the person who knows us best and stands ready to advocate for us.

Caregiver Galligan remains hopeful. “This is simply a merciful bill for a voiceless population”, he said.

(updated 1-21-26)

Advocates, providers on new Nursing Home mandates

Published in RINewsToday on April 29, 2024

In the shadow of Rhode Island’s ongoing staffing shortage, the Center for Medicare and Medicaid Services (CMS) issued its 329-page final rule on Nursing Home Minimum Staffing Standards (CMS 3442-F) on April 22 in the Federal Rule. 

CMS affirmed its commitment to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare-and Medicaid-certified long-term care facilities.  

According to CMS, over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.

Just the Nuts and Bolts

CMS say that central to its final rule are new comprehensive minimum nurse staffing requirements that would significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.  The agency is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities are given the flexibility to use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.

CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

This final rule provides a staggered implementation timeframe for facilities to meet the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors. The requirements of this final rule prioritize safety and health care quality while taking into consideration the unique workforce challenges some nursing homes are facing, especially those operating in rural areas. 

CMS will closely monitor and evaluate the provisions of this final rule, including but not limited to, the minimum staffing standards, the 24/7 RN requirement, the exemption process, and the definition of rural, as they are implemented over the next several years to determine whether any updates or changes are necessary in the future. 

Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

Provider, advocate positions on new CMS final rule

At press time, the RI Department of Health (RIDOH) had no comments about CMS’s new final rule released last week, say Joseph Wendelken, RIDOH’s public information officer.  The state agency is reviewing the rule and assessing its impact and applicability in Rhode Island,” he says.

With the final rules release, senior advocates and providers are expressing their opinion about its impact.

Former President Donald Trump, who is challenging President Joe Biden for the presidency, has not addressed quality of care in nursing homes with a formal position.  Kathleen Heren, Rhode Island’s Ombudsman, speculates that by releasing the CMS mandate before the upcoming presidential election, President Biden is just trying “to establish a record” of enhancing quality of care in nursing homes.

“Nursing homes cannot find  Registered nurses (RN), and Nursing Assistances to hire,” notes Heren.  The CMS mandate will force nursing homes to downsize, like we have just seen happen at the Scandinavian Home,” she predicts.

According to Heren, the final CMS rules do not include the minimum staffing of LPNs. More important, “it’s an unfunded mandate,” she says.

Gerontologist Deb Burton, MS, executive director of RI Elder Info, is pleased to see a Federal minimum staffing mandate of 3.48 hours of daily nursing care. “It’s important to understand mandates don’t make workers appear and a minimum staffing mandate is only an average amount of time allotted for care across all residents in the facility,” she says, noting that this rule doesn’t mean each resident will receive 3.48 hours of care each day.

According to Burton, the CMS Nursing Home Compare website, as of April 2024, notes there are 6 Rhode Island facilities that would not meet the lower federal minimum staffing mandate if it were enacted today. “The workforce shortage and the dire need to increase Medicaid reimbursements to attract and retain adequate staff with a proper wage are common topics of meetings,” says Burton. 

“When workers say ‘It’s only me on the floor – do I help the resident eat their supper or take the other resident to the bathroom? I can’t do both,’ – we need to listen,” says Burton. “The new federal minimum staffing mandate is a good step forward, but we need more. One day it will likely be us waiting for that workers’ help,” she warns. 

Like other RI senior advocates, Maureen Maigret, policy director for the Senior Agenda Coalition of RI, sees the importance of CMS releasing its final rules.  “It is important that these regulations have been finalized as providing for minimum nurse staffing levels in nursing homes helps  ensure residents across the country will receive quality and resident-centered care,”  she says. 

According to Maigret, Rhode Island has had a provision for 24/7 RN coverage even before the state’s minimum staffing law was passed so that is not a new requirement here. She pointed out the regulations will also promote transparency and accountability by requiring public reporting on how much of the Medicaid payments are spent on direct care staff and that the federal government has committed to invest over $75 Million in an initiative to increase the number of nurses working in nursing homes through such things as financial incentives for tuition reimbursement.   

“We are dismayed that the Biden Administration is moving forward with this one-size-fits-all staffing mandate,” says John E. Gage, President and CEO of the Rhode Island Health Care Association. “In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors in Rhode Island and across the country,” he warns, noting that when nursing homes can’t find nurses and/or certified nursing assistants (CNAs), they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need.

New final rule just another unfunded mandate

Like the 2021 RI staffing law, the Federal rule is an unfunded mandate, charges Gage. “Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers, he states.

According to Gage, nationally, the nursing home workforce has declined by 124,200 individuals (-7.8%) since the start of the pandemic. Rhode Island’s numbers are even worse, down 1,495 individuals (-15.3%). Gage calls on Congress to step up and support the bipartisan Protecting America’s Seniors’ Access to Care Act, which would prevent CMS from enforcing this unfunded and flawed mandate.

“Together with our national association, the American Health Care Association (AHCA), we will continue to fight for more common-sense solutions and do everything we can to preserve access to care for Rhode Island seniors,” says Gage.

“The good news about the Biden Administration’s final rule, there are phase-ins over multiple years that will provide an opportunity to challenge the mandates through legislation and/or possible AHCA litigation on the national level,” adds Gage. “The federal mandate highlights how much of an outlier RI’s staffing mandate is.  The RI statute has the highest staffing metrics and the highest fines in the country – 10% above the federal standards.  Without the Executive Actions of Governor McKee, RI nursing homes would be fined $90 million in the first full year of enforcement – devastating facilities and forcing further closures.  RI excludes hours worked by administrative nurses from counting toward the RN metric, yet they are included in the federal standards.  RI also excludes med techs’ and nurse aides in training’s hours from the CNA metric, while CMS includes them,” noted Gage.

Gage adds that the CMS final rules consider Rhode Island to be “urban.” As a result, the state has 2 years to phase-in the 24×7 RN requirement.

Rhode Island regulations and law have required 24×7 RN coverage in nursing homes for many decades, says Gage. “While challenging to maintain compliance given the shortage of registered nurses, this should not be a major concern for RI facilities,” he adds, noting that there will be 3 years to comply with the required 0.55 HPRD for RNs and 2.45 HPRD for CNAs. 

Additionally, Gage says that there are also waiver opportunities in certain circumstances.  “During the implementation phase, facilities and all stakeholders must be laser-focused on building a sufficient pipeline of qualified nurses and CNAs to the nursing home workforce,” he says.  

Like Gage, James Nyberg, executive director LeadingAgeRI, sees the CMS mandate as less onerous than the RI staffing mandate that “fortunately” remains suspended. “We remain concerned about the impact of this national mandate on providers in Rhode Island, and its broader impact on consumers and the health care industry,” he says.

According to Nyberg, the state’s current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (six nursing homes have already closed since the COVID pandemic began and two more have embarked on significant downsizing). 

“These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes,” says Nyberg, noting that LeadingAgeRI is working with numerous stakeholders on various initiatives to develop a pipeline of workers. “But the simple fact is that it will take time and an infusion of resources,” he adds.

“CMS proposes to spend $75 million on a nursing home staffing campaign.  That amount might help a state like Rhode Island, but that money is national, so it is a drop in the bucket in terms of the support the industry needs, states Nyberg.  “On the home front, we have been working with the Administration and the General Assembly to provide an infusion of funding to try and rescue the homes from their dire financial straits and try to stabilize the industry.  But the federal mandate, and all the related details and requirements embedded in the rule, do nothing to further that cause,” he says.

For the Minimum Nursing Standard final rules, go to https://public-inspection.federalregister.gov/2024-08273.pdf

For the CMS Fact Sheet  on Minimum Nursing Standard final rules, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

Shortage of direct care professionals a local and national concern

Published in RINewsTdoay on April 22, 2024

Last week, at  the Senate Dirksen Building, Room SD-562,  Chairman Bob Casey, of the U.S. Special Committee on Aging, (D-PA), showcased S. 4120, legislation that he introduced with U.S. Senators Tim Kaine (D-VA), and Tammy Baldwin (D-WI). The Long-Term Care Workforce Support Act, introduced during the 118thCongress, would ensure that direct care professionals have a sustainable, lifelong career by providing substantial new funding to support these workers in every part of the long-term care industry, from nursing homes to home care, to assisted living facilities.

The Senate Aging Committee details a number of statistical findings showing the need for Congress to address the nation’s severe ongoing direct care professional workforce shortage. “A recent survey revealed 92% of nursing facility respondents and nearly 70% of assisted living facilities reported significant or severe workforce shortages.

In 2022, a survey of nursing facilities showed more than 50% of the facilities were limiting the number of new admissions due to staffing vacancies or shortages.  Another recent survey of Home and Community Based Service providers showed that all 50 states were experiencing home care worker shortages, and 43 states reported that some HCBS provider groups have closed due to worker shortages,” says the fact sheet.

Addressing the cause

By improving compensation, benefits, and support systems, S.4120  would ensure the United States has a “strong, qualified pipeline of workers to provide desperately needed care for older adults and people with disabilities.” notes a statement announcing the introduction of Casey’s legislative proposal.  

Specifically, S. 4120 would increase the number of direct care professionals, especially in rural communities.  It also would provide pathways to enter and be supported in the workforce for women, people of color, and people with disabilities.

S. 4120 would also improve wage compensation for direct care professionals to reduce vacancies and turnover.  It ensures that direct care professionals are treated with respect, provided with a safe working environment, protected from exploitation, and provided fair compensation.

The legislative proposal also documents the need for long-term care, identify effective recruitment and training strategies, and promote practices that help retain direct care professionals. It also would strengthen the direct care professional workforce in order to support the 53,000,000 unpaid family caregivers who are providing complex services to their loved ones in the home and across long-term care settings.

At press time, S. 4120 is endorsed by 50 organizations, including Domestic Workers Alliance, SEIU, AFSCME, Caring Across Generations, National Coalition on Aging (NCOA), Justice in Aging, National Partnership for Women & Families, National Council on Independent Living (NCIL), and the National Disability Rights Network (NDRN).

And a companion legislative proposal was introduced in the House by Congresswoman Debbie Dingell (D-MI).

Senate Aging Committee puts spotlight on Direct Care Staffing Shortage 

The April 16th hearing entitled, “The Long-Term Care Workforce: Addressing Shortages and Improving the Profession,” examined the challenges currently facing long-term care workers who are often underpaid and overworked, leading to widespread worker shortages that threaten the availability of care for those who need it.  

“It’s a crisis that stems largely from a lack of support for and investment in our caregiving workforce,” warns Casey in his opening statement. “Between 50 to over 90 percent of long-term care settings and providers report significant staffing shortages, affecting their ability to provide services, accept new clients, or even to remain open,” he says.

Casey noted that many direct care professionals have to work multiple jobs or overtime just to be able to support themselves and their families.  In 2022, their medium wage was just above $15 dollars an hour, well below what is paid for warehouse and convenience store jobs, per Casey.

“The direct care workforce, the majority of whom are women of color, are more likely to live in poverty compared to the general public,” notes Casey.

“Cumbersome federal regulations, requirements, and protections” and a “one-size fits all approach” won’t fix the direct care staffing shortage, responds Ranking Member Mike Braun (R-IN).

“To grow the long-term care workforce, the federal government should make it easier for people to enter by removing barriers,” says Braun, in his opening statement, calling for “productive approaches to build and grow the care professions.”

Overworked and not enough money

Nicholas Smith, a direct support professional at SPIN, a Pennsylvania-based organization that provides lifespan services for over 3,000 people with intellectual disabilities and autism, came to testify. “I work nearly 65-70 hours a week… due to my work, I have missed family events, nieces’ and nephews’ recitals, and school functions… a lot of people are leaving this field to make more money,” said the Philadelphia resident who has worked in the long-term care industry for over 25 years.

According to Smith, the national average for direct service professional wages is only $15.43 in long-term care. “We spend time training new hires only to lose them because they cannot make a living wage,” he says, noting that other industries are offering more money.

“While people want to stay in this field, they cannot make ends meet. Pennsylvania has a long waitlist for home and community-based services, and this is due to the workforce crisis,” he says.

In her testimony, Brooke Vogleman, a licensed Practical Nurse with Huntington, Indiana based TLC Management, stated:  “I’ve seen what happens when long-term care facilities lack workers, resources and government support, like during the pandemic. Many of my colleagues got burned out and left the profession, forcing facilities to rely on costly temporary staffing agencies.”

Vogleman called on federal policy makers, including members of the Senate Aging Committee, to address the challenge through “targeted investments, not blanket mandates.”  

For instance, she told the Senators that LPNs are integral to the facility’s interdisciplinary team. “Staffing mandates that do not include our contributions to patient care or recognize us as nurses are very concerning to me and will have unintended consequences on residents,” she says.

Staffing mandates will force facilities to depend more on expensive staffing agencies, warns Vogleman. “Personally, I’m concerned they will actually increase staff burnout, as current caregivers will be stretched thin and working longer hours in order to comply with these impossible standards,” she says.

Matthew Connell, Ed.D., of Ivy Tech Community College of Indiana, came to share the work and achievements of his community college in addressing the shortage of healthcare and long-term care workers in Indiana.

According to Connell, serving more than 190,000 students at 19 campuses and 26 satellite locations as well as on-line, graduates more associate level nurses in Indiana.  Nearly half of these students are pursuing college credit while in high school. Ivy Tech is the nation’s single largest provider of dual credit.

Ivy Tech’s programs are especially designed to help graduates enter the workforce quickly and provide critical services for the state’s long-term care population at a tuition rate that is the lowest in the state, he notes. “One in three Registered Nurses [in Indiana] is an alum. More than 90% of its nursing graduates choose to remain in Indiana, working in hospitals and care settings,” he adds.

The last witness, Jasmine L. Travers, assistant professor at New York University’s College of Nursing,  concisely summed up how to fix the nursing shortage.  She suggested: “To improve access to and quality of long-term are, we must ensure that all direct care workers receive a living wage, a safe, respectful work environment, opportunities for advancement, adequate training, and accessible benefits to maintain their health and well-being.  Only when we recognize that these workers are critically important, hardworking processionals, can we begin to improve equity and health outcomes for staff and patients alike.”

Putting the spotlight on Rhode Island’s Direct Care Staffing Shortage

According to John E. Gage, MBA, NHA, President & CEO, of the Rhode Island Health Care Association (RIHCA), the Covid-19 pandemic had a dramatic impact on the healthcare sector across the country and especially in Rhode Island, and a disproportionate impact on nursing facilities. On a national level, in February 2020 nursing facilities workforce totaled 1,587,000. Today, it is 1,462,800, down by 124,200 or 7.8%. In Rhode Island, it is more dramatic. Pre-pandemic RI nursing facility workforce was 9,797 (2/2020). Current BLS data shows the most recent number of workers in RI nursing facilities is 8,300 – down 1,497 workers or 15.3%.  This is just about double the rate of loss of workers post-pandemic in RI compared to the national statistics.

“There are some local efforts to attract workers back to RI nursing homes,” says Gage, noting that there is a need to be laser-focused on workforce development efforts. 

Gage calls for RI Medicaid to increase reimbursements to nursing facilities to cover today’s actual cost of care, not on facility costs from 2011 (13 years ago!) with minimal average inflationary increases in the 11 years since the price-based reimbursement methodology began in 2013.  According to Gage, RI nursing facilities need an adequate, sustainable reimbursement system to foster continued high-quality care and services and provide nursing home with rates that enable them to retain current workers and recruit more caregivers.

RIHCA, a non-profit trade association representing more than 80 percent of the nursing homes in the state, and its parent organization, the American Health Care Association (AHCA) support the legislative efforts of Senator Casey’s Long-Term Care Support Act. “We support all efforts to increase Medicaid rates to enable facilities to regain and grow their workforce – both direct care and ancillary staff, to enhance the quality of care and quality of life for our nation’s and RI’s most frail elder citizens today and for the years ahead,” he says. 

“It is heartening to see the Senate Committee on Aging and leading members of Congress addressing the care worker crisis in long term care including supporting our many thousands of unpaid caregivers who provide a significant portion of long term supports and services,” says Maureen Maigret, policy advisory of the Senior Agenda of RI (SACRI). Multifaceted solutions are needed, adds Maigret that include supporting training programs for nurses and paraprofessionals, career ladders and providing adequate Medicaid provider payments as Medicaid is the primary payer for long term care.

According to Maigret, in homecare alone, 75% of persons referred for subsidized home and community care through the state Medicaid or the Office of Healthy Aging Home Cost Share program are waiting two months, and often longer, to get services. “Our nursing homes are challenged to recruit the nursing staff needed to provide resident-centered quality care. Federal funding during the pandemic brought some funding in to support worker wages but that funding has ended,” she says.

“The state Healthcare Workforce Initiative led by the Executive Office of Health and Human Services and the Department of Labor has been looking at needs across the healthcare system and addressing some of the training and education issues,” says Maigret, noting that advocacy groups, such as the SACRI, support the Medicaid reimbursement rate increases as recommended by the Office of the Health Insurance Commissioner. “These rate increases are necessary to reduce service wait lists and provide livable wages for direct care staff many of whom are women and women of color,” she says. 

Over 23 years ago, in his weekly commentaries in the Pawtucket Times, this writer reported on the crisis of a direct care staffing shortage and inadequate reimbursement being paid to  nursing facilities to care for Rhode Island’s fail seniors. Isn’t it finally time for the Rhode Island General Assembly to come up with the necessary funds and strategy to fix these problem once and for all?

To watch the Senate Aging Committee hearing held on April 16, 2024, go to https://www.aging.senate.gov/hearings/the-long-term-care-workforce-addressing-shortages-and-improving-the-profession