Low-wage workers prop up the nursing home industry. They're quitting in droves.
The Washington Post January 23, 2022
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WASHINGTON — In the eight years she has worked at nursing homes, LaToya Francis, 34, has been yelled at, kicked at and had feces thrown at her for little more than the minimum wage. She endured it because she loved being a certified nursing assistant, she said.
But she's not sure she can hold out much longer.
As the omicron variant of the novel coronavirus drives record staff shortages at nursing homes nationwide, Francis has increasingly found herself alone on her $19-an-hour overnight shifts at Bridgepoint Healthcare's skilled nursing facility in Southwest Washington, fighting off panic attacks as she tries to feed, clean and rotate more bed-bound residents than she can handle. Some nights, she retreats to a corner of the facility, where she calls her partner and sobs. Other nights, all she can feel is anger.
"I've never, ever felt this disrespected," Francis said.
Frustration is surging among the low-wage workers who make up the backbone of the nursing home industry, as tens of thousands of their colleagues call out sick with covid-19, inflaming shortages that already were at crisis levels. Hailed as "heroes" during the early months of the pandemic, these workers, most of whom are women and people of color, say they're facing untenable levels of pressure.
Government support has failed to end the crisis, advocates say, allowing care for the elderly and the infirm to worsen, forcing facilities to limit admission or close entirely and clogging up hospital beds. According to the U.S. Bureau of Labor Statistics, the nursing home industry has lost more than 420,000 jobs since the start of the pandemic, reducing its workforce to the size it was 15 years ago. Some employees chose to retire early rather than face the intense workload and coronavirus risks at their jobs; others have been lured away by companies, including Amazon, that offer wages with which nursing homes say they cannot compete.
And even as the coronavirus's omicron variant retreats, the staffing crunch will persist, nursing home leaders and unions say. At community colleges, interest in skilled nursing courses has plunged, with some class sizes dropping to half what they were before the pandemic. Of those training to become nursing assistants, many are avoiding nursing homes - where they would earn a median annual wage of $30,120, according to BLS data — and are looking instead for jobs as travel nurses or home health aides.
Meanwhile, the aging trend that the U.S. Census Bureau calls the "gray tsunami" looms ever closer, with all baby boomers — the original cohort was more than 70 million people — set to be at least age 65 by 2030.
That threat is now prompting alarm among elected officials over what workers such as Francis say they have known for years: They're essential but underpaid and overworked.
"This is a crisis on steroids," said David Grabowski, a Harvard researcher who studies the economics of long-term care. "The long-standing issue of underinvesting and undervaluing this workforce is coming back to bite us."
Bridgepoint Healthcare chief executive Marc Ferrell said that his company has tried to offer competitive wages but that it's a "well-known fact" that the nursing home workforce has shrunk.
"This is a national issue," he said, "not a Bridgepoint issue."
‘I can’t live like this’
Few places in the United States have been harder hit by the virus's omicron variant than the District of Columbia and the surrounding states, where new-case counts per capita rose sharply in early January, outpacing the rates of infection in many less-vaccinated jurisdictions.
In Virginia, where 9,500 or so nursing home workers have left the industry since February 2020, about 2,700 care workers have tested positive for the coronavirus this month. In Maryland, 7 in 10 nursing homes have reported new outbreaks, and as many as 5,000 workers have had to stay home after testing positive, said Joseph DeMattos Jr., the president of the Health Facilities Association of Maryland. Washington D.C.'s health department did not respond to inquiries on infections at its long-term-care facilities, but leaders at 1199 SEIU, a union that represents health-care workers in Washington, said the staffing situation has never been worse.
All three jurisdictions recently reissued states of emergency to ease the staffing shortages, including by extending the expiration dates for nursing licenses and allowing nursing graduates to start work more quickly. On Jan. 13, Maryland Republican Gov. Larry Hogan also implemented testing requirements for staffers and visitors at nursing homes.
But such efforts fall far short of what is truly needed, workers say.
"It seems like the folks in charge . . . are trying everything except what the front-line workers want," said Yvonne Slosarski, a spokeswoman for the 1199 SEIU Maryland/DC Division. "We know what actually retains workers: It's more pay, more leave and safer working conditions."
Rhonda Davis and Darrie Neely, both 61, agree. They left their nursing home jobs in Baltimore last year after contracting covid-19.
Neely, who previously worked 30 years as a housekeeper, said she passed the virus on to multiple members of her family in the fall of 2020, which is when she decided the nursing home job wasn't worth it. "No one wants to stay for the money that they're paying," she said.
Davis, who previously was a cook for 19 years, said she's passionate about caring for older adults but grew sick of spending vacation days working because her supervisors were taking months to replace employees. Isolating alone in her apartment last November, the decision to resign became clear. "I can't live like this," she remembers telling herself.
Davis said what she grew to resent was the inequity. Nursing home workers are the lowest paid in the health-care industry.
"Whether you scrub the floor in a nursing home or cook the meals, it matters," she said. "It matters to the residents."
Grabowski, the Harvard researcher, said the low pay for nursing home workers partly reflects the type of work and the type of worker that the country values. "There's some ageism, classism and racism at work here," he said.
But it also reflects the challenges of trying to fix an industry that is being taken over by large corporations, private-equity groups and investment-management firms seeking to profit off elder care, Grabowski said. The federal government is the biggest payer for long-term care through its Medicaid program. And while advocates within and outside the industry agree that nursing home workers ought to earn more, some worry that higher Medicaid reimbursement rates would just end up lining the pockets of facility owners, not staffers.
"If we're going to pay more," Grabowski said, "we also need to make sure the money is going toward what it's intended for."
A group of U.S. senators tried last year with the Nursing Home Improvement and Accountability Act, which would, among its provisions, establish minimum staffing levels at nursing homes and increase federal oversight of care. Some aspects of the bill were folded into President Biden's Build Back Better spending plan, which has been caught in congressional gridlock.
‘We’re going to get through tonight’
Meanwhile, hundreds of thousands of nursing home workers nationwide continue to clock in.
In Northeast Washington one recent evening, Francis leaned her 5-foot-9 frame over her kitchen counter, tapping on her phone to figure out her schedule. She recently started a second job as a home health aide, picking up shifts on days off to help with the mad scramble she goes through at the end of every month to afford rent ($1,250), car payments ($200), gas and food.
"My social worker just called," Candace Johnson, her fiancee, said. "We can get the car seat Tuesday."
"Oh, clutch," Francis replied, looking up. "Oh, wait, no, no. I'm working the new job Tuesday."
There was only one pickup day for the free seat. Johnson, 43, sighed.
"I know, that thing saves us $80," Francis said, biting her lip. "Let me check the schedule again."
Johnson nodded. She had quit her job as a mechanic last year after the symptoms of her sickle cell disease worsened, becoming a stay-at-home parent to Francis's two children. It hurt her when Francis called from work to say she was again the only certified nursing assistant in her unit, or when she found Francis holding back tears as she stripped out of her scrubs at the door, afraid that she may have brought the virus home. Most days, she said, Francis got less than three hours of sleep before it was time to pick up the children from school.
Gabriel, Francis's 11-year-old son, screeched. His 2-year-old sister was making a mess again. Francis marched into the little girl's room, picking her up with one hand and tickling her with the other. These two hours she had with her children before work were precious. Even when she was exhausted, she tried to be present.
"Good job, big girl," she said, stroking Everly's hair as she swung her hips to the soundtrack of "Frozen" blaring from a tablet.
In an ideal world, Francis said, she would be working during the day and taking classes at night to become a registered nurse. Other RNs had told her she'd be great at it, and she knew she would be, too. But she couldn't afford the time or the money, so she was stuck, she said, in a job that felt impossibly hard but far from "heroic."
"When I can't even spend time sitting with someone in hospice who is near dying because I know there are 14 other people waiting for me, I don't feel like a hero," she said. "How can I?"
Just after 6:30 p.m., Francis packed up her lunch and hugged her children.
"We're going to get through tonight," Johnson said as she kissed her partner goodbye. Francis tightened her mouth into a small smile and headed out.
The following night, as the city sheltered from a snowstorm, the nursing assistant did it all over again.