The employees who do much of the backbreaking work in Massachusetts nursing homes are lucky if they make $13 an hour — many make considerably less. Nearly half of those who bathe, feed, and care for residents need food stamps or other government assistance to survive.
Now, nursing home owners are lobbying for millions of dollars in Medicaid money to boost compensation for poorly paid workers, a campaign that has won the support of powerful advocates. But it will be up to an overwhelmed state agency to make sure the money really goes to workers, and that is fueling concerns, even among backers of the proposal.
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The trade group for the nursing home industry, the Massachusetts Senior Care Association, is urging lawmakers to earmark $90 million in the state budget for the worker pay campaign, and suggests a complex formula for how the money should be raised and spent.
The state House of Representatives is slated to unveil its proposed budget Wednesday. The spending plan released in January by Governor Charlie Baker included just $30 million for the campaign, but did not mandate the money be spent on workers’ wages.
Nursing home owners have pledged to devote most of the money to workers.
“We are calling on state leaders to invest in our workforce at a minimal cost to the state,” Ned Morse, the association’s president, said in a statement. “A living wage will help us retain dedicated staff, which maintains quality of life for our residents.”
The union that represents workers in some of the state’s 400-plus nursing homes joined with nursing home owners this week to fight for the increase after expressing earlier concerns.
Leaders from 1199SEIU United Healthcare Workers East said they wanted assurances most of the money will go to higher wages for workers.
“We will work together with the association to make sure that much of the money appropriated for the workers goes to the workers,” SEIU spokesman Tim Foley said.
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A pay raise, even $1 more an hour, would mean the ability to buy a few more fresh vegetables, said Sharon Brown, a 53-year-old certified nursing assistant who works in a Medford nursing home by day and an assisted living facility by night. Brown lives in a two-bedroom Dorchester apartment with two of her grown children and a granddaughter.
“When I turn around, I have another bill coming at me,” Brown said. “I have to put off seeing a doctor because I don’t have that money to put down sometimes.”
Brown said she cares for 10 nursing home residents on each shift, and often is exhausted as she heads to her night job.
“All the call lights are going, people are vomiting, I run to get the call lights, and two or three people want to go to the bathroom at the same time,” Brown said.
The nursing home association said many owners are having trouble recruiting and retaining workers for these jobs because of low pay, and owners say a state freeze on Medicaid payments to nursing homes since 2009 is the primary reason wages have stagnated.
Advocates for the elderly who have agreed to back the campaign said they hope lawmakers will include language that assures strict monitoring of how the money is spent.
“Most people are supporting this with an asterisk to make sure the money goes to the right place,” said Austin Hodge, public policy manager at the Alzheimer’s Association of Massachusetts and New Hampshire.
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The nursing home association’s plan calls for the state’s health and human services department to monitor the program. It is not clear how the health agency, which has weathered cutbacks in recent years, would manage oversight of the wage initiative.
The last batch of annual nursing home financial reports to be audited by the state were from 2010.
A Globe review of 2014 nursing home finances found facilities frequently report they are losing money. But records from companies affiliated with the nursing homes show they are directing cash to subsidiaries and to help pay executives’ six-figure salaries.
A national study released Tuesday on nursing home finances and workers’ pay by the Paraprofessional Healthcare Institute found “little accountability for how nursing homes spend public reimbursements (Medicaid and Medicare) that pay for the majority of nursing home residents’ care.”
The institute, an advocacy organization for health care workers, found that nearly half of nursing assistants and personal care aides are so poorly paid, they rely on food stamps or other public assistance.
Massachusetts nursing home owners say all but $12 million of what they are seeking would be devoted to workers’ wages and benefits. Nursing home owners say the money that would come back to them is a tax they pay the state.
That money is owed because of an arcane process Massachusetts uses to leverage more cash from the federal government. The state in effect taxes nursing homes. The plan proposes increasing that tax by $15 million annually (most of which would be returned to nursing homes). That, in turn, would yield $15 million more in federal cash.
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The rest of the new money would come from an additional $36 million paid by the state Medicaid program, which would yield an identical amount in matching federal cash.
Kay Lazar can be reached at Kay.Lazar@globe.com. Follow her on Twitter @GlobeKayLazar.