OHCA The Oregon Caregiver Fall Winter 2021

The Oregon Caregiver FALL/WINTER 2021 www.ohca.com 18 PUBLIC POLICY I n less than two years, the long term care sector has learned how to be resilient in many ways large and small. The COVID-19 pandemic required a fundamental shift in how providers and caregivers approach infection prevention and control, resident social and emotional wellbeing, business operations, and much more. Even as new variants of the virus emerged, the sector has largely been successful in adapting to clinical circumstances created by the pandemic. Now, a new challenge poses an urgent threat to the health of the long term care profession and older Oregonians who need services and supports: the work- force crisis. According to the Bureau of Labor Statistics, nursing facilities and community-based care providers nationally lost 380,000 employees between February 2020 and July 2020, a trend not seen by other industries. The need for registered nurses (RNs) in all licensed long term care settings is particularly important to advancing quality care outcomes and nurses are becoming harder to recruit and retain. In addition, long term care settings rely on certified nursing assistants (CNAs), certified medication assistants (CMAs) and unlicensed direct care staff. These essential, compassionate, and competent frontline workers are critical to deliver- ing quality care and services. Staffing challenges are not new, but they were made significantly worse by COVID-19. High burnout rates, ongoing federal stimulus and unemployment benefits, market competition, and wage inflation from other industries, skyrock- eting staffing agency contract costs, and vaccine mandates have created an emergent crisis. It is also important to examine COVID’s workforce impact through an equity lens. The pandemic has had a particularly acute impact on women as public schools transitioned to remote learning and childcare duties increased. Since more than 80 percent of long term care caregivers in Oregon are women, this means our sector has felt these impacts more than others. With all this in mind, the Oregon Health Care Association (OHCA) understood that proactive public policy solutions and provider support strategies were neces- sary for long term care to manage the pandemic while simultaneously keeping caregivers working in facilities to care for residents. That’s why we advocated for—and were successful in passing— several new initiatives during the 2021 legislative session that will allow provid- ers to stay competitive. One pressing issue has been the rapid and sustained wage growth, not includ- ing existing minimum wage increases, which has cut across nearly all sectors. Providers were already feeling a labor squeeze and, as a result, many took action to raise wages throughout the pandemic. However, OHCA members needed additional financial support to stay on this trajectory in a sustainable way. OHCA helped craft an “Enhanced Wage Add-On” program available to all licensed long term care providers with the goal of incentivizing and supporting rising wages. Nursing facilities receive an additional four percent Medicaid rate enhancement if they pay a starting wage of a $17 an hour starting wage for all CNAs, and home and community-based care providers receive a 10 percent rate enhancement if they pay a $15 an hour starting wage for all direct caregivers. The program went into effect on October 1 and, if successful, OHCA will work to continue this program into the next biennium. In addition to compensation, caregivers have voiced an interest in access to health insurance plans better suited to their needs and life circumstances. As wages rise, more workers in long term care settings will become ineligible for Medicaid. In fact, the Oregon Health Plan anticipates purging nearly 200,000 Oregonians from its rolls as pandemic- related programs expire. Senate Bill (SB) 800 is a potential solution to improving access to health insurance for caregivers across the sector and is a voluntary program for providers. It would do so by establishing a labor-employer trust that would offer a health insurance product for participating employers. The Oregon Legislature agreed with the vision and dedicated $30 million in the 2021–23 biennium for the program, which will pull down federal supplemental Medic- aid payments in addition to employer contributions. Wages and benefits are one piece of the puzzle. Oregon must also pursue strategies that will have immediate, short-and long-term impacts on the staffing crisis and that support worker retention and growth. These strategies include mitigating cost increases from temporary staffing agencies, expanding the education and training pipeline, implementing wraparound supports for workers, streamlining the regulatory environment, and more. The OHCA government relations team will prioritize workforce policy solutions and investments in the 2022 legislative session that not only attract and keep caregivers in buildings, but also increase the overall availability of a workforce with competencies to meet the needs of Oregon’s aging population into the future. Libby Batlan is the senior vice president of government relations at OHCA. Combatting Workforce Challenges By Libby Batlan, Oregon Health Care Association