$20,000 signing bonus, anyone? Nursing homes still struggle to recruit and retain staff


Last year, Caribou Rehab and Nursing Center had more certified practical nurses than there were CNA positions.

The Aroostook County Nursing Home typically employs between 60 and 65 health care aides, administrator Phil Cyr said. Last year, these positions were replaced 74 times. In a typical year, it could replace 25 or 30 DACs.

Cyr said one of the reasons for the high turnover rate is that he expects a high level of skill from employees. Sometimes the positions change three times before he finds a good fit.

But it is increasingly difficult to find quality candidates. Cyr offered $20,000 signing bonuses last fall to attract new employees, using state recruiting assistance funds. He initially offered bonuses of $5,000, but had to keep increasing the amount when his initial offer didn’t get much attention.

Maine nursing homes are struggling to fill positions as the work is difficult, low-paying and increasingly dangerous during the COVID-19 pandemic.

This month, MaineCare reimbursement rates increased to allow 225 long-term care facilities across the state to pay their direct caregivers 125% of minimum wage, or $15.94 an hour.

Long-term care officials and administrators called the increase a “welcome first step,” but stressed that more needed to be done to recruit and retain workers.

Cyr said it was too early to tell how much the rate increase might help his establishment. When rates go up, Cyr said it usually takes a few months to see the “hard numbers” of what it will actually mean for individual installations.

“It won’t hurt,” Cyr said. “The extent to which this helps will only be determined after seeing what they are talking about.”

The rate increase, approved by lawmakers in the last session and signed into law by Governor Janet Mills, was to take effect in July 2022. But Mills late last month brought forward the timetable to deal with the crisis of workforce across the state.

“For the remainder of this fiscal year, rate increases will prioritize installs that are below the 125% threshold, with the degree of increase varying based on currently reported salary levels,” said Jackie Farwell, gatekeeper. word of the Ministry of Health and State. Personal services. “From July 1, 2022, the rates will be adapted to each establishment according to their labor costs.”

Funding for recent rate adjustments is subject to legislative approval, so there may be a delay before rates actually change.

“Our direct care workers deserve a salary that matches the important work they do for the people of Maine,” Mills said in a press release at the time. “I hope that increasing these rates will allow facilities to increase staff salaries in the new year and help them recruit and retain engaged and caring workers.”

Mills also said she will propose in her supplemental budget an additional $7.6 million to help nursing facilities cover labor costs through the end of fiscal year 2022. And she said asked DHHS to waive penalties on low occupancy nursing facilities.

Raising wages is an important first step but cannot be the only solution, said Angela Westhoff, president and CEO of the Maine Health Care Association, which represents 200 nursing homes and assisted living facilities across the state.

Historically, reimbursement rates have not kept pace with rising labor costs, Westhoff said. “It’s a chronic problem.”

Facilities need help retaining current workers with more training opportunities, pay raises and promotions so workers feel they are growing professionally, Westhoff said. There must be “multiple entry points” into careers, including offering more CNA courses to bring young people into the workforce.

Pay only part of the picture

It is also important to consider “package support” for workers, including childcare, affordable housing and transportation. Traditional childcare centers close at 5 or 6 p.m., which can make it difficult for parents who work from 11 p.m. to 7 a.m. in a nursing home, Westhoff said.

A lack of affordable housing was one of the main reasons Island Nursing Home in Deer Isle has not reopened since it closed last fall, the Bangor Daily News reported. At least 26 applicants declined job offers because they could not find accommodation in the area.

Island Nursing Home was one of five Maine nursing homes that closed last fall. Many cited staffing as a major reason.

Including the five last year, 18 Maine nursing homes have closed since 2012.

Westhoff said she’s excited about a new state-funded healthcare recruitment campaign using federal dollars from the US bailout, which includes $500,000 to promote direct care professions.

Mills previously distributed about $123 million last fall to nursing homes for staff recruitment and retention.

Cyr, of Caribou Rehab and Nursing, said those funds would likely be more helpful than MaineCare’s rate hike. His institution received approximately $1 million in recruitment and retention funds.

Cyr used the funds to provide significant signing bonuses and reward good behavior and low absenteeism.

Cyr said Maine has done a better job than other states of supporting nursing homes.

“Maine nursing homes are blessed with what they got from the state of Maine,” he said.

Endangered species: caregivers

Part of the workforce problem is that the pandemic is driving healthcare workers out of industry, Cyr said.

“It drove up wages because there weren’t enough healthcare workers to keep everyone happy,” he said. “And so we kind of rob each other with higher salaries.”

CNAs — the backbone of nursing homes — still deserve better pay, Cyr said. He starts them at $16 an hour, but thinks it should be $20. He can’t do it without higher MaineCare reimbursements.

“If he doesn’t come in, he can’t come out,” he said. “You can’t pay for what you never had.”

Dr. Jabbar Fazeli, spokesperson for the Maine Medical Directors Association and medical director of two southern Maine nursing homes, said he suspects many facilities are already paying direct care workers at least 125% of the state minimum wage. Those rates have increased over the past two quarters, he said.

The increased reimbursement rate will help “level the playing field” for smaller facilities, he said.

“Running costs differ from facility to facility, so I suspect it will be much more useful for smaller, more cash-strapped facilities,” Fazeli said. “Maybe rural settlements with fewer resources, that could make a difference, at least in the short term, for them.”

But with a shrinking pool of workers, establishments are increasingly turning to agency workers, who have much higher rates, because they can’t attract full-time employees at current salaries.

“It’s nice that (the rate increase) levels the playing field and facilities are able to better compete for the same workers, but in situations where there aren’t enough workers for all the world, something has to give,” Fazeli said.

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