Official seal of ARRA
As states struggle to balance their budgets in the face of a deep recession, there has been little good news for long-term care.
At least three states, however — North Dakota, Montana, and Oregon — are using funds from the American Recovery and Reinvestment Act (ARRA) to stabilize and enhance their direct-care workforces.
North Dakota
On May 4 the North Dakota Legislature passed a comprehensive $2.28 billion bill to fund the state’s Department of Human Services (DHS). The legislation included a provision of $41.3 million for wage increases for workers in nursing homes and basic care facilities (BCFs), as well as for Developmental Disabilities Services Providers (DDSPs) and Qualified Service Providers (QSPs). The latter are the state’s in-home care providers, both agency-based and independent, who provide personal care services to seniors and people with physical disabilities.
Money for the wage increases comes not only from the state general fund that is appropriated for Medicaid services but from the increased federal share of Medicaid payments (FMAP) under ARRA. The upshot is that on July 1 all of the above-named workers will receive raises of either $0.80 per hour or $1.00 per hour, along with an annual inflator of 6% for 2009 and 2010.
DHS and the North Dakota Long Term care Association (NDLTCA) tell PHI that although it is the intent of the legislation to use the specified appropriations for wage and benefit increases for long-term care workers, the legislation does not specifically mandate this. But DHS is taking steps to ensure that the intent is honored.
The new legislation resulted from advocacy efforts since last September by NDLTCA in partnership with the North Dakota Association of Community Facilities (NDACP). NDLTCA expects the legislation to benefit most of state’s 18,000 long-term care workers.
Montana
Montana has assigned more than $16 million to increase wages for its 12,000 direct-care workers. The website for the Montana Department of Public Health & Human Services (DPHHS) shows how the department’s share of ARRA funds — $513 million in federal and state funds — will be allocated over the biennium to DPHHS programs.
As explained at the DPHHS web page, $16.3 million of these funds will be used “to fund a one-time direct care worker wage increase for Medicaid services in the Senior and Long Term Care Division.” The increase will apply to “direct care and ancillary service staff for the 2011 biennium only,” and will benefit “nursing facility providers, personal assistance providers, and other community based service providers.”
As for the method by which the money will actually be paid to workers, Ted Dick, political director for SEIU Healthcare 775NW, tells PHI that it won’t actually come in the form of an increase in hourly wages. “It might be paid as training funds, or possibly as a one-time only wage increase in the form of bonuses,” he says, adding that because the ARRA money is a one-time arrival, such methods “really are the most efficient way to appropriate them.”
Dick says he spoke recently with Kelly Williams, an administrator in the Senior and Long Term Care Division of DPHHS, and that although she is “still working the numbers out,” there is a plan afoot to pay two lump sums to Montana’s direct-care workers, one in July and then another in January.
Oregon
The Associated Press reported on March 28 that Oregon lawmakers were talking about using a combination of state and federal dollars to help pay for more than 300 new nursing assistants in long-term care facilities in all 36 Oregon counties.
The Oregon Department of Human Services (DHS) reports at its website that “ARRA provides DHS and local governments an estimated $807 million of increased Medicaid funds retroactive to October 1, 2008, through December 31, 2010.”
Jim Scherzinger, Deputy Director of Oregon’s DHS, tells PHI that as of mid-June the plan to create the 300 nursing assistant jobs is still moving forward and is “definitely happening.”
For more information, see PHI’s April 2 post: Oregon to Create Nursing Homes with Stimulus Funds.
These three states have clearly stepped up to the plate to address issues of careworkers in long term care.
North Dakota looks like it could provide a wage increase to workers but with no assurace the funds would actually be used this way.
The Montana plan calls for $16 million for workers which may be in the form of training (who determines quality, accessibility, relevance?)and one time bonuses for workers in the future.
The Oregon plan would provides funds to train 300 new NAs but with no assurance they will be appropriate for the job nor have a potential to remain in position. How much better to put funds into stabilizing the existing workforce.
While we commend these states for trying to address issues of direct care, we also wonder if consideration has been given to using these funds to stabilize the existing workforce and build stonger career paths that will help to keep good workers at the bed side.
Genevieve Gipson RN MEd RNC
National Network of Career Nursing Assistants
I have to agree with you. I can see the funds being used to improve esthetics in facilities desiring to increase curb appeal and improve their census. This would stand to serve the owners in the form of heightened profits, but does nothing for the employee. In addition, it does nothing to improve the care the residents receive.
The CNA has the most difficult job in any facility due to the fact that they are with the resident more than any other employee, and have to work with the residents when they are truly at their worst. It requires mounds of patience, love, and a very strong desire to help those who cannot help themselves. The good ones are very dedicated to their residents and would do the work no matter the pay. That is not the point. I have worked with many who worked three jobs to make ends meet. The result is fatigue, burnout, frustration, and the potential for abuse. Educating and stabilizing the existing workforce by providing consistent wage increases would help to keep those dedicated CNA’s at the bedside as you have pointed out.
A one time bonus may be gracious, but is not likely to solve long term financial issues. Food, clothing, housing, insurance, and transportation are but a few of the concerns facing these workers who are forced to survive on minimum wage income. I have heard so many times, “Everything goes up but our pay”. It is long overdue for these workers to rise to the level of their peers in being able to financially sustain themselves and their families.
I fear the funds will not find their way down the most useful path. It is the CNA’s, and subsequently the resident’s, who so deserve a boost.