By Cole Casarez, SEIU 775 Nursing Home Member
Between the two of us, we have over fifty years of experience in providing long-term health care. Today we work in our respective roles as an SEIU 775 represented Certified Nursing Assistant and an Administrator in a Skilled Nursing Facility (nursing home) here in Spokane. We each chose our lines of work because we love to help people. That’s why we’re standing together now to raise the alarm on a worsening workforce shortage and concerns about our state’s ability to provide care to the 12,800 older adults who rely on Skilled Nursing Facilities throughout our state. Now is the time to increase investments to stabilize our workforce, not to propose horrific budget cuts.
In a Skilled Nursing Facility, we provide care for older adults who require support for intense needs related to chronic medical treatments, cognitive impairment, and condition management including cancer, kidney failure, and tracheotomies. Day in and day out we ensure that our patients have full bellies, clean bodies, appropriate medication, and – especially for those receiving memory care – a stable routine. On a practical level, since we see them every day and care for their most basic needs, we feel as close to them as to our own families.
However, this critical model of care faces a looming crisis. Sixty percent of the older adults in Skilled Nursing Facilities rely on Medicaid to access services. Medicaid funding is set by the State Legislature and they have made significant investments in long-term care models, but our current Medicaid payment system is based on costs from 2022. You don’t have to work in long-term care to know the painful realities of high inflation in recent years. The real costs for supporting patients with Medicaid exceed state funding by more than $60 million per year across the 197 Skilled Nursing Facilities in Washington. This threatens our state’s ability to lower barriers to accessing long-term care for those who need it.
What’s more is that wages don’t keep pace with the cost of living and companies are unable to offer affordable high-quality healthcare insurance, so many frontline health care workers in nursing homes go without insurance or leave the industry to find a job that has better benefits. We’re then faced with staff vacancies and job ads posted endlessly. When we are forced to supplement with more expensive agency-provided contractors, there‘s often agitation among residents and frustration among staff because of the time spent orienting new people to our routine who will then move on to another facility the next day.
For the 11,000 trained Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants who make up two-thirds of our workforce, the wages and benefits offered are simply not competitive when compared to hospitals, clinics, physician offices, and other healthcare employers. For those of us who choose to stay because we love our residents and work, even though a less-demanding field would be easier on our bodies, many of us are already working a second job to pay for our own healthcare costs.
We are tasked with providing excellent care to human beings and are striving to meet the requirements of state staffing minimums implemented in 2016, a policy that supports a high-standard of care. However, the Legislature’s investment in long-term care must catch up with the cost of goods and services today, especially as we anticipate a 35 percent increase in adults 75 and older who will rely on long-term care supports by 2029. Washington staffing hours per resident, per day already ranks higher than the national average, but we are not matching our commitment to quality care with the requisite funding from the Legislature required to make it happen.
The State Legislature is currently considering permanent solutions to stop relying on temporary fixes that have acted much like a single band-aid on a bleeding wound. Together, as an administrator and a caregiver, we urge them to permanently adopt annual Medicaid rebasing legislation to keep up with the rising costs of today’s world. Furthermore, it is essential that we address the long-term workforce crisis by passing the Essential Worker Healthcare Program and offer affordable, quality healthcare to those who are caring for our community’s residents in need.
Every day, we have the privilege of caring for adults who are quirky and fun, and whose families are grateful. Our state must take action now to preserve and expand skilled nursing care for those who need it. We hope our community can continue to do so for decades to come.
Cole Casarez is a Certified Nursing Assistant and SEIU 775 member at North Central Care Center in Spokane and has served his community as a CNA for ten years.
Dell Workman is an Administrator at North Central Care Center in Spokane and is celebrating his 40th year in the field that his grandmother inspired him to enter.