The General Assembly and Gov. Daniel J. McKee’s administration face key questions about the state’s budgetary priorities. What will Rhode Island do with its projected $610 million budget surplus? In an environment dominated by higher inflation and a possible recession, it’s important to invest the surplus in ways that stimulate economic growth and generate long-term returns for taxpayers. In his state of the state address, McKee declared that “the best way to lessen the impact of an economic downturn is to invest in J-O-B-S.”
Rhode Island can do just that by increasing the supply of essential caregivers to support the state’s long-term care providers. The shortage of certified nurse assistants is not confined to the Ocean State. David Cutler, a health economist at Harvard University, observed that “there are simply not enough workers for all of the jobs that health care employers want to fill.” As a recent report from the Rockefeller Institute noted, “it will be important for state policymakers to be ready to implement additional strategies to alleviate workforce shortages.”
The General Assembly’s passage of the Nursing Home Staffing and Quality Care Act in 2021 established the nation’s strictest minimum staffing ratios for long-term care facilities, but it also created a Catch-22 for nursing homes. While failure to meet the new staffing requirements would result in significant financial penalties, a shortage of CNAs has left facilities unable to hire the workers needed to meet these new minimum ratios. In February 2022, McKee issued an executive order suspending the financial penalties for noncompliance, but unions and other supporters of the law continue to defend the new staffing rules. New York’s experience, however, offers a cautionary tale for Rhode Island policymakers. In the wake of the state’s new staffing requirements, more than 6,000 nursing home beds in New York are now unfilled due to staffing shortages, forcing some facilities to turn away new residents. In short, minimum staffing ratios cannot address the underlying problems with the state’s long-term care workforce. Without enough workers, the industry faces an impossible choice between paying millions of dollars in fines or limiting admissions to remain in compliance.
Rather than punishing facilities for failing to hire enough workers, policymakers have an opportunity to invest in a model health workforce development program. Nursing homes are competing for workers with Amazon.com, Target, Walmart and other service sector providers that often pay as much as, if not more than, caregiving positions that require individuals to complete a specialized training program. Minnesota offers a blueprint for legislators to create a program to strengthen the state’s health care workforce. Beginning in December 2021, Minnesota dedicated $3.4 million of its American Recovery Act funds to recruit and train 1,000 new CNAs. The program paid for free CNA training classes – as well as books, uniforms and the cost of the certification exam. The program exceeded even the most optimistic expectations, training more than 1,370 new CNAs in the span of nine months. In September 2022, Minnesota Gov. Tim Waltz announced an additional $2.4 million investment in the program so that “families can continue to rely on talented, highly qualified nursing assistants to provide critical care for their loved ones.”
Rhode Island has an opportunity to invest in a new generation of caregivers in 2023. Writing in the Journal of the American Medical Association, Victor Fuchs – a health economist at Stanford University – argued that “to simply return to the pre-pandemic health care system … would be a mistake. This is a time to think more boldly about the future of the US health care system.” Investing in health care workforce development is an opportunity for Rhode Island policymakers to think boldly. Training more CNAs would alleviate critical staffing shortages, create jobs and protect the health of vulnerable patients. The need is acute, and the time is right.
Robert B. Hackey is a professor of health sciences at Providence College.
