STATE NURSING RATES IMPACT MOST VULNERABLE

Brockton, MA [March 23, 2022]

Angelina is a vibrant young woman who loves spending time with friends and being active on social media. She is like most people her age, except Angelina, who has complex medical needs resulting from cerebral palsy.

In 2015, Angelina moved into a community-based group home with round-the-clock nursing support and a team of counselors to help her with everything from eating, dressing, and going to meetings. Unlike a nursing facility, these homes are specially designed to promote the freedom and independence of medically compromised individuals striving to live active lifestyles within their community.

BAMSI, a Massachusetts non-profit, operates the group home Angelina lives in, along with 89 other homes for individuals living with various disabilities. Of those homes, 20 are for the most medically fragile, like Angelina. The houses are cozy and inviting and feel like a home rather than a hospital.

BAMSI and a handful of other providers in Massachusetts operate these homes in partnership with the state as part of a class action settlement to move people needing long-term care out of hospital and nursing facility care into community-based settings.
As part of BAMSI’s contract with Massachusetts, the state sets the rates it is willing to pay for a variety of services. Currently, the state’s nursing rates are well below the state average, resulting in severe staffing shortages and exasperating the staffing challenges these homes face.

Barbara Gordon, the Vice President of Healthcare Services at BAMSI, laments, “We just can’t hire nurses at the rate the state provides, so we are forced to contract with a staffing agency at an even higher rate to make sure our people get the care they need.”

BAMSI has invested in paying its nurses $3 per hour over the state-contracted rates in hopes of attracting talent, but the increase is both unsustainable without increased funding and still short of the market rate.

“I love my job, very much, but I am really not sure how much longer I can stay,” said Valerie Walker, a BAMSI Nurse, who struggles to justify remaining with BAMSI.

“We do a lot here as nurses to keep the people we serve safe, yet my colleagues in other organizations make $10-$20 more than I do.”

For people like Angelina, staff shortages and turnover can have serious consequences. If not carefully tended to, her condition can rapidly deteriorate, requiring extended hospitalization where she is confined to abed.

These shortages can prevent Angelina from doing the things she enjoys most, like using her racing wheelchair to compete in local races and serving on BAMSI’s Persons Served Advisory Board.

“Raising the nursing rates for medically complex group homes is just better for everyone,” said BAMSI CEO Peter Evers. “Without the right care, our people will be hospitalized, costing the state thousands of dollars a day while seriously diminishing the quality of life of the people we serve.”

Currently, BAMSI is part of a legislative delegation urging the commonwealth to increase its rates to allow these programs to remain open, accessible, and viable for medically fragile individuals.

DESPERATE PROVIDERS URGE THE STATE TO RAISE NURSING RATES

In 2020, the Commonwealth of Massachusetts lowered the rate it paid for nursing care for medically fragile individuals living in state-funded group homes.

Nonprofits operating these homes on behalf of the state are now left scrambling to fill positions and retain talent without compromising care —some risking financial solvency to bridge the pay gap caused by the state’s actions.
A series of class-action lawsuits beginning in the late 1990s mandated theCommonwealth de-institutionalize people living with developmental and intellectual disabilities and acquired brain injuries who had previously been confined to hospitals and nursing facilities.

The Commonwealth contracts with nonprofit agencies to fulfill this mandate, paying a set rate for a bundle of services. Although rates increased for most contracts in 2020, the rates paid to operate homes for medically fragile individuals were effectively reduced.

BAMSI, a Brockton-based nonprofit, operates 90 groups homes across the state. Eighteen of them are devoted to caring for medically fragile individuals. Each home accommodates 5-6 individuals with complex medical needs and includes ventilator support, oxygen therapy, tracheotomy care, and 24 hours a day nursing support. The 2020 rates resulted in a $40,000 a year deficit for each medical home, which the agencies were expected to absorb.

COVID and the resulting Great Resignation have had a tremendous impact on nursing. Salaries have increased across the country. In order to compete, agencies like BAMSI have had to increase nursing pay above the state rate, incurring further unfunded debt.
“This is not sustainable, and if the state expects us to continue to provide this level of care to such a vulnerable population, they have to be realistic about the cost,” said BAMSI CEO Peter Evers.

A delegation of agencies operating medically fragile group homes on behalf of the commonwealth is working to persuade the legislature to renegotiate rates.

Evers laments, “We specialize at caring for individuals that need the most support and our staff has just spent the last two years working tirelessly, going above and beyond to keep the people we serve safe and healthy during the pandemic. It’s a shame the state is not fulfilling its end of the bargain.”