Why Missouri’s assisted healthcare system is sick

Working as a union representative for SEIU Healthcare in the state of Missouri has been an educational experience I never expected. My union, the Service Employees International Union Healthcare Illinois, Indiana, Missouri, and Kansas, represents all forms of service­-based healthcare positions – from nursing home workers to hospital techs to homecare to childcare to building maintenance to housekeeping.

Coming from the building trades, I was used to a project-oriented worker management environment of good wages and a “do your job  –  payday is Friday” mindset.

At SEIU however, I’ve witnessed healthcare workers in a suffocating environment that is dubious from start to finish. Like most atrocities, the private, for-profit healthcare system is largely kept from public view and discussion.

Simply put, nursing homes are not hospitals and facilities are rarely specialized. Doctors are not present and nurses make up most of the administration, while the majority of the care provided is done by CNAs, Certified Nurses Aids.

Additionally, nursing homes are not just for senior citizens who need caretakers. They also include psychiatric patients, veterans, and those needing physical rehabilitation. And the current trend toward home assistance has created a “low census” (low population), which has led to a consolidation of residents, which in turn has done away with specialized wards.

Funding for nursing homes is another convoluted matter. For the most part, there are very few privately funded beds industry-wide in Missouri. The majority of residents’ stay is paid for by Medicaid. In order to be eligible for Medicaid in Missouri you cannot earn more than $4,400 annually and  must have no major assets or significant savings.

In other words, residents are forced to engage in a “spend down.” They have to spend their savings and sell assets, in order to receive Medicaid. In fact, most nursing homes will charge higher rates during the spend down period until the residents’ assets make them eligible for financial assistance.

That a majority of residents pay through Medicaid often creates an income ceiling for nursing homes, and unfortunately, a ceiling for employee wages. Generally, since necessary materials and overhead are non­negotiable expenses and since management is not going to sacrifice pay, profitability can only be expanded by low wages or by degrading the quality of healthcare services provided.

The median income for nursing home workers in Saint Louis is about $9.50 per-hour, while the public perception is that nursing home workers are making $18 to $22 per-hour. The low wages for such a demanding, high-risk profession perpetuate high levels of staff turnover. And high turnover is often a catalyst for a  toxic work environment, low morale, inexperienced staff and instability for residents.

Homecare is the fastest growing sector of the assisted healthcare industry, but homecare has a completely different set of pitfalls. Only last year did homecare workers gain the right to a minimum wage. Unsurprisingly, there has been considerable opposition to these workers earning minimum wage, or to organizing with a union.

Currently, the majority of homecare workers are non­union. The state funds care by paying a for-profit staffing agency, which then provides the care givers. The assigned care givers operate independently and usually only talk with each other when and if they pick up their checks in person at the agency, making organizing that much more difficult.

The argument from right-wing, anti-union forces is: “Higher wages make it impossible for those in need to pay for services.” The argument from democratic, pro-union groups is: “Higher wages will attract more highly qualified and skilled caregivers who provide better services to residents.”

It should be repeated that most nursing homes are privately owned and are therefore a profit­making institutions. However, the profit margin is usually in the 10 percent range. While most nursing home corporations own several to several hundred nursing homes, others are family­owned, where family members hold administrative positions and profit through generous salaries.

Therefore, the margin of profitability is expanded through a decrease in quality, care, low pay and bad working conditions. Dietary nutrition, building maintenance, staffing levels, modernization, environment, and level of service are all sacrificed to pad the nursing home’s profit margins.

Furthermore, once residents are settled in a nursing home, the system makes it difficult to relocate to a different facility if they are dissatisfied with their conditions. And there is little incentive on behalf of nursing homes to improve conditions for the residents.

Obviously, most people do not find this a “romantic topic,” but we all grow old. Where will we be housed when we can no longer care for ourselves?

Currently, SEIU Healthcare is creating a community roundtable to discuss this very topic. The planned roundtable includes union members, non­union members, facility administration, advocacy groups, the faith community, other community groups, political leaders and the media.

Missouri is a political battleground over the expansion of Medicaid, which if successful could change the dynamic of assisted healthcare for the better. The growing mindset that “no one should profit from healthcare” offers a promise of a single­payer system that would turn the current system on its head – for the better.

Perhaps the answer lies in looking at other nations who have a non­profit system of healthcare. Whatever the answer, the current industry of assisted healthcare in Missouri is not healthy.

Nicholas James is a union representatice for SEIU Healthcare in Missouri.