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A Call for Quality Care and Fair Wages: PHI Statement on H.R. 7513

By Amy Robins (she/her) | March 28, 2024

Last fall, the Biden Administration released proposed regulations that acknowledged the critical links between job quality, workforce recruitment, retention, and care quality in nursing homes. It represents the most significant nursing home regulatory reform in decades and PHI celebrates this major step forward. Today, however, the House of Representatives is currently considering legislation that would block its implementation. If passed, H.R. 7513 would be a significant and damaging step backward for both nursing home staff and residents.

The poor quality of direct care jobs—limited training and advancement opportunities, a general lack of support and recognition, and, especially, inadequate compensation—prevents many long-term care providers from delivering optimal care and meeting demand. According to PHI’s most recent workforce estimates, the 2022 median hourly wage for nursing assistants in nursing homes was $17.06, which represents only a modest increase over the last 10 years (when adjusted for inflation). Median annual earnings for nursing assistants were just $25,748 in 2021 (the most recent year available), 39 percent lived in or near poverty (defined as less than 200 percent of the federal poverty line), and 40 percent relied on public assistance programs to meet their basic needs.

Poverty-level jobs harm the economic security of nursing assistants and push many of them out of this sector. As CMS notes in the proposed rule, because industries such as fast food and retail pay higher wages than direct care—and can offer better schedules and less dangerous work—long-term care (LTC) employers cannot compete with these other industries. As a result, retention in this sector is in crisis: the median annual turnover for nursing assistants in nursing homes was nearly 100 percent in 2017-2018, according to the most recent research available.

H.R. 7513 is a response to opponents of the rule who have argued that nursing homes will be unable to comply with the stronger staffing requirements due to workforce shortages and will ultimately be forced to close, reducing access to care. Rather than eliminate the proposed rule, PHI urges Congress to focus on measures that ensure a viable path to compliance for nursing homes. The proposed rule is an important step towards recognizing the essential role the direct care workforce plays in delivering LTC, improving health outcomes and quality of life for older adults and people with disabilities, and strengthening the economy overall. The proposed rule increases the transparency of how Medicaid dollars are used to compensate workers and moves incrementally toward addressing the longstanding issues of low wages and difficult working conditions that have contributed to workforce shortages in the LTC industry.

Nurse assistants care for our nation’s most vulnerable people. They deserve the progress inherent in the CMS proposed rule. PHI urges Members of Congress to soundly reject H.R. 7513 and support full adoption of the proposed rule.

Amy Robins (she/her)
About The Author

Amy Robins (she/her)

Senior Director of Policy
As PHI’s Senior Director of Policy, Amy Robins is responsible for designing and leading PHI's historic and growing nationwide advocacy approach.

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