We are facing a long term care crisis. With people living longer and the aging population increasing at a rapid rate, long term care needs are growing against the backdrop of a dangerous caregiver shortage. Seniors, people with disabilities, caregivers, and their families are crying for help, and our politicians must work to develop solutions as they outline their healthcare reform proposals to the American voter.

Reform for our long term care system is long overdue as we reach the precipice of a Silver Tsunami. By 2030, California’s population over the age of 65 is expected to increase from 5.2 million to 9 million, necessitating 3 million additional long term care workers. By 2026, California will need at least an additional 15,800 Certified Nursing Assistants.

Though nursing home workers and homecare workers provide two different modes of essential care, one thing remains clear across both sectors: these workers are our forgotten frontline in defending our country’s most vulnerable population. And long term care facilities have emerged as the most visible display of Covid-19’s negative impact.

The simple fact is more seniors live longer and their needs for long term care assistance are changing. More people are living independently in their homes, and need greater help with their medications, physical and occupational therapy, transportation, housekeeping, bathing, and cooking meals. Whereas those with more serious chronic conditions will rely on facilities such as nursing homes and specialized elder care that require more trained people.

Long term care workers serve as a safety net underneath America’s patchwork healthcare system, making sure that seniors and the disabled don’t slip through the cracks. This safety net, however, has been tattered by an accelerated aging population and torn by policies written by opportunistic politicians and for-profit corporations.

What has been laid bare in over the course of the pandemic has been sobering and stark. The uncomfortable truth of this moment is that we aren’t confronting just one crisis — the pandemic — but two. Our long term care system isn’t prepared for either. There are things that can be done to fix this, but they must be done now to give us any chance at turning things around. In the short term, we need healthcare for every worker, including paid sick leave and 100%-paid testing and treatment for Covid-19. These workers also need — and deserve — “pandemic pay” that reflects the essential nature of their work.

I’ve heard our members’ stories and know the realities they face. Our union advocates and welcomes to work with legislatures to create a plan and system that propels longer term solutions. They must include:

• Evaluation and reconfiguration of the Medicare system which currently incentivizes nursing home employers by rewarding higher payments for short term patients;
• Full transparency of corporate systems to ensure that profits contribute to a higher quality of care and not executives’ bottom lines;
• Training for infection control and creating a career development program that includes disaster preparedness with regular upskilling allowing for workers’ healthcare growth opportunities; as well as a recruitment program to fill current short-staffing and the future needs;
• Pay and benefits that demonstrate the value of nursing home workers not just in this moment, but moving forward and always;
• Further investments in recruiting and training workers to meet the growing demands of the aging population.

And these solutions are only a start. We must continue to address the pervasive, fundamental imbalance in our state budget plagued with structural deficits that have only revealed further the deep inequities in our economy and our healthcare system. We need reform to increase access, contain costs, improve consumer choice, and help seniors and others needing long term care services by strengthening and expanding home and community-based services. This requires not only recruiting and training a workforce, but also ensuring these jobs pay enough to sustain a family and keep quality people on the job. Our current market is failing our workers by generating low-wage, high-stress jobs that lead to high turnover as workers are forced to hold a second or even third job to support themselves and their families.

In California, where the facilities have been especially impacted, the nursing home industry’s workforce is predominantly women (81%), immigrants (54%), and people of color (86%). Furthermore, the median annual earnings of nursing home workers is $23,000, with 10% of caregivers living in poverty and 53% living in low-income households. By profession, nursing home workers average some of the lowest wages in the healthcare industry.

As of 2018, according to California’s Office of Statewide Health Planning and Development (OSHPD), licensed vocational nurses had an average hourly wage of $28.58, with certified nursing assistants averaging $15.65. These are wages that frequently force workers to take on multiple jobs at more than one facility to make ends meet.

Many facilities are also part of corporate chains owned by investors hiding behind LLCs, amassing dozens of properties that take in hundreds of millions in Medicare and Medicaid funds. UC San Francisco professor Charlene Harrington’s research shows these private chain facilities also have lower staffing and more regulatory problems than nonprofit or state-run facilities. In California, nearly 90% of nursing homes are privately owned, with 75% owned by corporate chains.

With the new Medicare reimbursement system that went into effect last fall, nursing homes are paid substantially more for new patients — like those released from a hospital — particularly for the first few weeks. Under those guidelines, Covid-19 patients can bring in upward of $800 per day. By contrast, facilities collect as little as $200 per day for long-term patients with dementia, for example.

It’s also been clear these inflated fees are not paying for adequate safety measures; from 2015 to 2019, ten of the largest administrations across the state of California collectively received 4,345 citations and/or penalties. Nursing Home data on health deficiencies show that in their latest inspection prior to the pandemic, nearly 70% of California nursing homes did not have and were not implementing an infection prevention and control program.

The culmination of these failures is breeding a private-sector nursing home industry constructed to avoid accountability, built on a regulatory and reimbursement structure that emphasizes profit over standards, care and working conditions. On the ground, inside these nursing homes, we have had workers earning a poverty wage, almost always women of color, caring for our elders amid a pandemic, without the most basic protective medical gear.

How do we make long term care an integral part of America’s healthcare system; and when are we going to make caregiving and long term care a profession that allows people to have a living wage to raise a family?

It is more clear than ever that we need drastic, systemic reforms to the long term care system not just in California, but across the country. If we don’t overhaul the system and overhaul it now, the worst is yet to come.