The novel coronavirus, by definition, is a new phenomenon. While its impact in Iowa is unprecedented in recent history, it also has brought much-needed attention to some old problems.
Case in point: The workforce shortage in Iowa’s long-term care facilities. Advocates for the elderly and disabled have been sounding the alarm for years, but it took a deadly infectious disease pandemic to earn widespread awareness among Iowans.
Nursing homes have been hit hard by the coronavirus pandemic, with almost every facility affected. Residents there make up less than 3 percent of Iowa’s population, but account for about half the state’s COVID-19 deaths.
The state is prioritizing care facility residents and workers in the rollout of COVID-19 vaccines, which started in the United States this past week. Iowa leaders expect everyone in those facilities who wants a vaccine will be able to get it by early next year. That’s a welcome development, bolstering the health of the workforce, but it alone will not solve the staffing shortages in our health care systems.
The causes of the workforce shortage are not difficult to understand.
Iowa’s population is aging quickly and growing slowly. The state simply does not have enough working-age people to fill jobs, throughout the economy but especially in skilled sectors such as direct care.
At the same time, chronic underfunding of health care and social services by the state and federal governments makes it difficult for care facilities to offer competitive wages that would attract new workers.
John Hale, an advocate for older Iowans and caregivers, is among those who have been raising concern about staffing levels in care facilities since long before the coronavirus pandemic.
“Employers, in many cases, cannot find people to fill the openings, or if they do, too many leave within the first few months because they find the work too difficult, and the pay, training and benefits inadequate,” Hale wrote in a Gazette guest column in June 2018, almost two years before Iowa’s first COVID-19 diagnosis.
Yet the COVID-19 pandemic has made the situation even worse. Some front-line workers have been sidelined due to illness or left their jobs out of fear thereof.
Given the lack of adequate staffing levels in Iowa and elsewhere, state and federal officials delivered guidance this year allowing workers with positive COVID-19 cases to continue working as a last resort when replacements are not available. It’s a grim trade-off that might have been necessary, but certainly isn’t sustainable.
The state government must adequately fund services and also seek out ways to support the long-term care workforce.
In the Iowa Legislature next year, the Iowa Health Care Association — which represents long-term care providers, skilled nursing facilities and assisted living programs — will ask lawmakers for a Medicaid rate increase totaling more than $30 million, which would be the biggest increase on record.
Care facilities already faced financial challenges before the pandemic, exacerbated by new COVID-19 testing and reporting requirements this year. Personnel is far and away the largest expense for the long-term care industry. Budget crunches inevitably will impact workers’ wages and benefits.
However, lawmakers should be cautious about filling the full request without assurance that employees will be taken care of. The state could consider policies that direct greater funding to organizations offering higher wages and better benefits.
Additionally, workforce development organizers should recognize health care, and specifically long-term care, as a crucial segment of their attraction and retention campaigns. Programs such as Future Ready Iowa are largely focused on technical and trade work, which is a very worthy endeavor but overlooks one of the biggest sectors of the economy.
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Time marches on and Iowans will continue to age. Over the next 20 years, the portion of the population age 65 or older is expected to grow, while younger age groups are projected to be stagnant.
Supporting Iowa’s long-term care industry holds multifaceted benefits — it will chart a course to provide for our aging population, while also strengthening Iowa’s economy and workforce. Lawmakers would be wise to take bold action in 2021.
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