Michigan’s long-term care facilities face many challenges in recruiting and retaining workers, and industry representatives hope lawmakers can help.
More than two million of Michigan’s residents are over age 60, which represents 25 percent of the state’s population. Lawmakers discussed the care long-term facilities provide for these citizens during a Michigan House Appropriations Subcommittee on Health and Human Services meeting last week.
“We understand as a state that we really have to be intentional about the resources we’re putting in place for our aging population,” Rep. Christine Morse (D-Texas Township) said. “And we thought it was important to have a hearing dedicated to aging and long-term care services so we can hear from organizations that are working in this area so we can plan for those resources as we budget for 2025.”
Scott Wamsley—director of the Bureau of Aging, Community Living, and Supports at the Michigan Department of Health and Human Services—said one of the biggest challenges facing long-term care facilities and home care workers is a shortage of direct care workers. He said the state currently has a shortage of 36,000 direct care workers, which include certified nursing assistants, home health aides, hospice aides, home care workers, and personal care assistants.
“This problem is impacting all of our service delivery networks, and certainly is a significant challenge for us,” Wamsley said. “We are working with the industry to look at nursing facility rate reform, trying to move our rate process to more of an acuity-informed process to support health and safety of the workforce to focus on quality, and to simplify the rate-setting process.”
Richie Farran is vice president of government services at the Health Care Association of Michigan, which represents about 360 nursing facilities and 240 assisted living communities in the state. He said facilities are implementing strong recruitment and retention efforts, as 78 percent of them have offered bonuses (including sign-on bonuses), while 70 percent have promoted staff and 69 percent have paid for staff training and education.
“Even with these efforts, workforce challenges persist. And it’s mainly due to a lack of interested or qualified candidates. Unfortunately, that’s leading to access issues.”
— Farran
About 46 percent of Michigan’s nursing homes have limited new admissions, while 38 percent have had to turn away potential residents on a weekly or monthly basis, Farran said.
Don Saldia, director of the Kalamazoo County Area Agency on Aging, discussed the shortage of ombudsmen in the state. Ombudsmen are neutral third parties who advocate for residents of licensed nursing care facilities. Michigan has 4,610 licensed facilities and 103,549 licensed beds, with only 20 long-term care ombudsmen serving them. The state would need 33 more ombudsmen to reach the national average of one ombudsman per 2,000 licensed beds (its current ratio is one ombudsman per 5,177 beds), he said.
Getting Michigan up to that national average would “help ensure that our older adults are protected, that their rights are given to them,” Saldia said. “And if they want to either age at a facility or get advocacy to see if they can age back into their community, we need to increase that funding.”
The state would need to add about $3 million to its projected fiscal year 2025 budget to add those 33 ombudsmen, Saldia said.
Bob Brown, executive director of Region Seven at the Area Agency on Aging, said staffing restrictions have made it impossible for the agency to see as many clients as it should.
“In my service area that has one ombudsman for 10 counties, we’re reaching six (clients) a day. We should be reaching 20 a day. There is a need for it. It needs to improve because these folks are the only police many of these people have, because their families are gone.”
— Brown
Salli Pung, the long-term care ombudsman for the state, discussed the Michigan Long Term Care Ombudsman Program.
“We work to investigate and resolve resident concerns, but only at the direction of the resident,” Pung said. “Concerns related to abuse, neglect, exploitation, eviction or discharge, hospital dumping, functional eligibility for Medicaid, guardianship, or harm to a resident are our top priorities.”
While those types of concerns require an ombudsman response within two working days, less serious complaints require a response within seven days, Pung said. Ombudsmen completed over 3,200 cases with just 20 staffers in fiscal year 2023.
“Generally, ombudsmen respond to high-priority concerns within a day or the day they receive them, and all other concerns within a few working days,” Pung said. “But they have to prioritize complaint work over other ombudsman services. There is a national recommendation for the state to fund the program at one to 2,000 that came out of the National Academies of Sciences, Engineering, and Medicine report from 1995. In 1995, there were probably fewer complex issues in nursing homes than what we see today. So that one to 2,000 ratio will help, but I don’t know if that’s the benchmark we want to end at.”
Wamsley discussed some proposed long-term care investments for 2025. He said the Department of Treasury has been working on an initiative to provide a Caring for Michigan Family Tax Credit to support caregivers. The tax credit would provide up to $5,000 for qualified caregiving expenses for caregivers who have at least $7,500 in earned income. It would apply $37.5 million in general fund revenue to help offset the amount of state income taxes owed by caregivers of aging and sick relatives.
“There’s also a non-direct care wage investment in the 2025 budget of $14 million to provide increased wages to non-direct care nursing home staff (housekeeping, maintenance, laundry) to support the infrastructure that helps keep individuals supported in a nursing facility outside of the direct care workers themselves.”
— Wamsley
Teri Langley, executive director of Disability Network/Michigan, said the state needs to implement another direct care worker rate increase as well, despite last year’s 85-cent raise.
“While the governor’s proposed fiscal year 2025 budget maintains the 85-cent increase from last year, the cost of living continues to rise, and the ability to survive on those wages lowers,” Langley said. “Because direct care worker wages in Michigan’s behavioral health system are directly tied to Medicaid funding, which has not kept pace with the needs of our state. These workers bring home very small paychecks and often have no other benefits.”
Langley requested a $20 an hour minimum wage for the 50,000 direct care workers within the state’s behavioral health system.
“Most direct care workers in Michigan make an average of $16 an hour,” Langley said. “Many are leaving the profession. They’re working at fast food restaurants because the pay is more, and the work is less. This exodus is causing thousands of residents to face emergency situations in which care is not available to them, chronic or extended hospitalizations, dependence on family members for ongoing care, and the loss of their independence.”
Wamsley also noted that the MI Health Link program will be transitioning to a highly-integrated dual special needs plan.
“It’s a specific type of Medicare Advantage plan designed to meet the needs of those dually eligible for Medicare and Medicaid,” Wamsley said. “It provides a number of opportunities for us in terms of moving from a demonstration project to a more permanent statewide project. It also allows us to build off some of the successes in the MI Health Link program. We’ll be issuing a request for proposals in early 2024. We plan to award contracts in the fall of 2025, and our program will start Jan. 1, 2026.”
Readers interested in learning more about Michigan’s long-term care challenges can register for the 2024 Michigan State of Reform Health Policy Conference, which will be held on April 4 at the Lansing Center. A “D-SNPs, LTSS & Integrating Long-Term Care in Michigan” panel will be held at 10:45 a.m., while an “Implications of Healthcare Workforce Shortages” panel will be held at 1 p.m.