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Why nursing homes say they're losing staff, how the state could help

Hearing room of the state legislature includes a row of seated lawmakers and two testifiers seated at their own table
New York NOW
Lawmakers hear testimony on challenges facing nursing homes and other long-term care services Tuesday.

Staff at New York’s nursing homes aren’t paid enough to compete with entry-level positions in other industries, which health care groups told the state Legislature Tuesday has led to average turnover rates in recent years as high as 94%.

Those workers are typically paid at or near the minimum wage, which ranges from $12.50 an hour in upstate New York to $15 an hour in New York City.

Fast food workers, in comparison, are paid at least $14.50 statewide — higher than the minimum wage in other industries. That’s led to caregivers leaving the health care industry for other jobs, the groups said.

“The key difference between a job at McDonald's and a job at a nursing home should be a career, that you're beginning a career,” said Dora Fisher, the director of long-term care at the Healthcare Association of New York State. “We believe we need to build that infrastructure.”

Speaking at a public hearing on challenges faced by nursing homes and other long-term care facilities, several health care groups said the amount reimbursed for those services by the state through Medicaid hasn’t been enough to raise wages for workers.

“I think it’s clear that the issues of workforce and reimbursement, particularly Medicaid reimbursement, are inextricably linked,” said Stephen Hanse, president of the New York State Health Facilities Association, which represents nursing homes.

“As we look at staffing, and staffing mandates, we’d love to hire more staff if we could. So, we need to address the workforce crisis. We need to address reimbursement.”

The state Legislature, earlier this year, approved a bill that mandates minimum staffing levels at nursing homes based on the number of residents and, more specifically, the amount of direct care required for those individuals under law.

At the same time, lawmakers and Gov. Andrew Cuomo declined to set a distinct minimum wage for those workers. But even if they did, those facilities wouldn’t be able to afford it without raising costs for residents, representatives from those groups said.

“For most facilities, that means you’re passing it on to the resident, who has a fixed income,” said Lisa Newcomb, executive director of the Empire State Association of Assisted Living. “So, something’s got to give at some point.”

Those groups pointed to the state’s current Medicaid reimbursement rates for nursing homes and long-term care facilities, which representatives said was too low to raise wages while maintaining the same level of service.

Through Medicaid, New York reimburses part of the cost of care for low-income residents of nursing homes and long-term care facilities, but not always all of it. Hanse said that gap comes out to about $8 per hour for workers, the rest of which they have to make up.

Some lawmakers at the hearing were sympathetic to those concerns. Sen. Jessica Ramos, a Democrat from Queens who chairs the Labor Committee, said the typical wage for those workers doesn’t reflect everyday costs for New Yorkers.

“You know, on average, we spend around $16,000 in child care every year,” Ramos said. “And if you put that up against the wages that these workers are paid, they're really left with nothing.”

The state Legislature could mandate higher wages for those workers, but support for that idea hasn’t garnered support from a majority of lawmakers.

The state Department of Health, which sets the state’s Medicaid reimbursement rates, said in a statement that the formula for calculating the state's spending on nursing homes is based on several factors.

“As required by State law, Medicaid reimburses nursing homes an amount per day that considers the region in which the nursing home is located, a wage factor and the overall acuity of the residents of the nursing home, often referred to as case mix," the agency said in a statement.

"Additionally, Medicaid reimbursement supports worker wages, including New York’s statutorily required minimum wage schedule.”