Advocates celebrate new rules governing nursing homes, home care: ‘This is about dignity’ 


April 26, 2024

Care advocates across the nation this week are celebrating two new Biden Administration rules aimed at improving care in nursing homes and raising the salaries of home and community-based workers after years of organizing by patients, care workers, and their allies. 

The first rule will require nursing homes to provide 3.48 staffing hours per resident per day and have a registered nurse on site at all times. Vice President Kamala Harris said 75 percent of nursing homes nationwide are understaffed – advocates described the new rule as the most significant change nursing homes have faced since the 1970s. 

The second rule mandates that at least 80 percent of Medicaid payments for home care go to salaries for workers, thus forcing private companies that supply workers to monitor their overhead costs while at the same time not siphoning off Medicaid funds to supplement profits. Home care worker pay is low – in 2021, state median wages for workers ranged from $8.76 per hour in Louisiana to $17.45 per hour in Massachusetts, with a national median of $14.15. 

Harris announced the two rules at a roundtable event in La Crosse, Wisconsin, where she was joined by SEIU members who work in nursing homes. 

“This is about dignity. This is about the dignity we, as a society, owe to those who care for the least of these,” Harris said. “This is God’s work: to care for people you’ve never met before, you’re not related to. And you care for them as if they’re a member of your family. Everyone would want that for themselves orfor a member of their family. Let’s recognize the gift these talented professionals give.” 

Lisa Briggs, a Milwaukee Certified Nursing Assistant, was one of the SEIU members who participated in the roundtable with Harris and recounted her experiences as a care worker of 28 years. 

Biggs said there have been times when her nursing home facility was so understaffed that there were only two workers on a floor. She said it is frustrating for both the workers and the residents of her nursing home – she remembers one person she cared for who loved to walk. 

“When we were short-staffed, we couldn’t walk her, so then she’d be real frustrated,” Biggs recalls. “I’d be like, ‘I’m going to do it tomorrow. I promise. I promise’. And you know, sometimes it happened. Sometimes it didn’t.” 

Many of the speakers – as well as other SEIU leaders – spoke of the importance of the two new rules in addressing racial inequality. Nursing home and home care workers are disproportionately women, disproportionately Black, and disproportionately immigrant. 

“As a Black woman, we are in a moment where folks are saying our diversity isn’t important,” April Verrett, Secretary-Treasurer of SEIU Wisconsin, told WEAU. “It just stiffens my spine and makes me willing to work harder and harder for justice cause that is really what we are talking about.” 

Departing from her scripted remarks, Harris said, “There are people in our country that suggest that to focus on diversity, equity, and inclusion is a bad thing…which includes the issue of pay equity by gender.” 

In a statement, SEIU President Mary Kay Henry said the new rules will benefit workers and patients alike, and will address historic inequities. 

“The correlation between job quality and equal access to care is clear, and both rules are fundamental to transforming care jobs into sustainable, sought-after careers,” Henry said. “Care workers – the majority of whom are women of color – have been underpaid and undervalued for generations due to a legacy of racism and sexism. These rules are also major investments in an essential workforce that has been historically left behind.” 

The new rules were first announced in September, when industry officials and members of the public were given the opportunity to submit comments. Nearly 47,000 comments were submitted, and pushback from industry groups representing nursing homes was fierce. 

“It is unconscionable that the Administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage,” said Mark Parkinson, President and CEO of the American Health Care Association, according to the Washington Post. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers.” 

But care advocates counter that the nursing home industry’s profits are robust – a recent study, for example, found that in 2019 nursing homes recorded about $11 billion in profits. 

What’s more, stories abound of patients suffering due to staffing shortages. 

The 47,000 comments submitted in response to the proposed rules included observations of people lying in their own filth for hours, not being fed appropriately and being left on the floor to long after falling, Secretary of Health and Human Services told the Post. 

“These are the kinds of things that drive nightmares in the minds of family members,” he said. “If you’re claiming that you can’t find nurses, then explain to me how you’re running a nursing home.” 

More than 13,000 CHN supporters have sent letters to Congress demanding that more money be invested in the care economy – you can take action here. 

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