As part of his undeclared candidacy to be California’s next governor, U.S. Health and Human Services Secretary Xavier Becerra paid a pandering visit in April to the Los Angeles headquarters of an SEIU local and reportedly stated to the caregivers there that “we owe you a salary that respects you.”

OK, so where would the money come from for that commitment? Certainly not from a contemptible one-time $75 million “workforce investment” Becerra has trumpeted as somehow offsetting the multibillion-dollar cost of an unfunded nursing home staffing mandate.

The ballyhooed $75 million will not even come from the coffers of a federal government able to boast it spent $37 billion on home- and community-based settings (HCBS). It will instead be paid for by nursing homes themselves through fines. 

In response to criticism that this funding is inadequate, a federal government FAQ document vaguely asserts, “There is a lack of transparency on how nursing homes manage and spend available funds.” The apparent inference is that the sector is sitting, Scrooge McDuck-like, on a pile of $6.5 billion in unspent annual revenue it can use to pay for new federal expectations.  

Treating nursing homes as his campaign bête noire may yet pay off for Becerra, but his demagogic public rhetoric, including suggesting the mandate will ensure nursing homes are not “a death sentence” for residents by effectively blaming nursing homes for the COVID-19 pandemic, is beneath the dignity of his office. It bears repeating that a study found that in the deadly year of 2020, the pandemic was more likely to kill those 65 and older in Medicaid HCBS than in nursing homes. 

Far from valuing caregivers, the staffing ratio in the final mandate inexcusably marginalizes licensed practical nurses (LPNs) to a degree that it could perversely cause nursing homes to fire LPNs to hire nurse aides, who are counted fully. As of May 2023 data, there were 171,290 LPNs working in nursing homes, accounting for just over 12% of all workers, and their mean annual wage was $63,730, compared to $55,380 in hospitals.

So, it seems nursing homes, if not the federal government, are already paying LPNs “a salary that respects you,” even if Becerra doesn’t respect LPNs. 

As was noted in a recent academic article, “The LPN workforce is the most racially and ethnically diverse cohort of nurses in the United States.”  It is also overwhelmingly composed of women. 

What is it about this profession — the bedside strength of nursing home care — that warrants its callous mistreatment under the staffing mandate?

Becerra, who has not drawn a private sector paycheck since 1985, reportedly believes nursing home caregivers earn what “burger flippers” make. As he was confronted in a congressional hearing with a photo of the empty parking lot on a workday at the headquarters for the Centers for Medicare & Medicaid Services, which houses around 4,000 workers, it’s possible those working under him are no more in touch with reality. 

Furthermore, in congressional testimony, Becerra has not offered any financial support that “respects” nursing home caregivers. Instead, he has bloviated about the administration’s proposal for more survey enforcement, a floggings-not-support plan that sets up a very jarring contrast with the administration’s proposal to give HCBS care another $150 billion.

Despite receiving no help from the Biden administration and being squeezed by Medicaid underfunding, nursing homes have led healthcare sectors in wage increases. Data shows average wages were 26.5% higher in January than they were in February 2020. That belies any claim that the mandate is needed because nursing homes are not spending enough money on their workforce. 

Like the flim-flam $75 million, the mandate is objectively built on political artifice and feigned concern for caregivers.

Brendan Williams is the president and CEO of the New Hampshire Health Care Association.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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