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    Distribution of Mass. nursing home aid questioned

    LM Otero/Associated Press/File

    Last year, nursing home owners successfully lobbied for millions of dollars they said was desperately needed to boost wages for their lowest-paid workers who do the back-breaking work of bathing, feeding, and caring for some of the state’s most frail residents.

    But a new report shows those who toil in these jobs — nurse’s aides, and those who clean, cook, and do laundry — received among the smallest bonuses awarded by nursing home owners from the $35.5 million allotted by state lawmakers.

    Instead, the largest bonuses were handed out to the more highly compensated workers, according to the report from the Massachusetts Executive Office of Health and Human Services.

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    Some nursing home workers typically received tiny raises — a median, hourly pay increase of 89 cents, worth about $1,850 annually — from the infusion of state cash, the report showed. In other cases, lower-paid workers got one-time bonuses typically around $400, while bonuses for some higher-paid workers were often nearly twice as much.

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    Advocates for nursing home workers and patients insist that’s not how the program was supposed to work.

    “The fact that the money was not used for the intended purpose is extremely disappointing and works against what needs to be done to improve care for nursing home residents,” said Arlene Germain, president of Massachusetts Advocates for Nursing Home Reform, a nonprofit patient advocacy group that had been skeptical the state money would end up helping the most needy workers.

    But state officials said most of the nursing homes are in compliance with the regulations for distribution of the money. State lawmakers have already approved a second pool of $35.5 million for nursing homes, though details on how that money will be spent won’t be available until next year.

    Nursing home owners applauded the state’s financial commitment, saying their ability to increase workers’ wages depends on adequate state funding.

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    Tara Gregorio, president of the Massachusetts Senior Care Association, a nursing home trade group, said in a statement the organization is “very pleased” with the state’s report.

    “Nursing homes have successfully implemented the wage pass-through with significant increases for frontline workers such as [nursing aides] and other eligible staff,” Gregorio’s statement said.

    Nursing homes had pressed hard for more state financial support, portraying the money as a boost for the least well paid. A November 2015 report from the trade association when it launched its initiative focused exclusively on boosting wages for four groups of low-paid workers: nurse’s aides, and those in housekeeping and laundry services. There was no mention of needing more money to help people in higher-compensated positions, such as registered and licensed practical nurses, who were described as holding positions that already “pay a family-sustaining wage.”

    State lawmakers were sold on helping the poorest workers. State Senator Harriette Chandler, now the acting Senate president, championed the pay cause, telling the Globe in September 2016: “The whole point of this was to reach the people really in the trenches, who do the heavy-duty labor in the nursing homes, so they aren’t having to work two or three jobs to pay their rent and put food on their table.”

    Nursing homes were given wide latitude in how they spent the first batch of increased funding, as long as it was spent between July 1, 2016, and Sept. 30, 2017. They were allowed to select which workers received increases, and the amount of the bonus, pay raise, overtime, or other additional benefit, as long as it went to workers in any of eight staff positions. Those positions included: registered nurses, licensed practical nurses, certified nursing aides, dietary aides, housekeeping aides, laundry aides, activities staff, and social workers.

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    It’s difficult to know exactly how big the hourly wage increases were for workers in each category because the report provides only the overall median increase to all workers: 89 cents per hour. And that figure may be misleading because nursing homes were allowed to count other items they paid, such as overtime and benefits costs, toward their reported 89 cent hourly wage increase.

    About $7 million went to one-time bonuses paid by the nursing homes. The report details those payments, making it clear that the highest-paid workers typically got the biggest payments.

    The report shows that registered nurses, who earn a median hourly pay of about $29, according to industry data, received a median one-time bonus of $736. Licensed practical nurses, who earn a median hourly wage of about $25, also received among the biggest bonuses, with a median of $716.

    But nursing aides, who earn a median hourly wage of about half as much as registered nurses, received a median bonus of $525.

    And aides who work in food service, housekeeping, and laundry, many of whom are paid the state mandated minimum wage of $11 an hour, received significantly smaller bonuses, ranging from $329 to $418, the report showed.

    Elissa Snook, a spokeswoman for the state’s Executive Office of Health and Human Services, said state officials worked closely with nursing homes to make sure the $35.5 million was spent according to state regulations. Roughly $3 million of that total is not accounted for in the report, and regulators noted that some nursing homes are in the process of awarding payments.

    “The majority of the Commonwealth’s nursing facilities are in full compliance, and we are working with those who are not to ensure the direct care add-on funds are used to benefit direct care workers,” Snook said.

    Commonwealth Medicine, a public service consulting and operations division of the University of Massachusetts Medical School, designed a Web portal for nursing homes to report their pay raise data and also analyzed the information, Snook said.

    Roughly 14 percent of 388 nursing homes did not submit enough information for regulators to determine if they followed the rules, and they are required to provide additional material. Another 9 percent did not comply with the rules, meaning they did not spend the entire amount they received to pay staff bonuses, wage increases, or other rewards as required, according to state regulators.

    Nursing homes that did not comply will have until Jan. 30 to address the problem, regulators said. State officials say they will take the money back from facilities that fail to comply and financially penalize them as well.

    Tim Foley, assistant division director at 1199SEIU United Healthcare Workers East, a trade group that represents workers at 34 Massachusetts nursing homes, said the state has to do a better job ensuring that public money is spent fairly.

    “As we continue to improve upon this program, the nursing home workers of 1199SEIU want to ensure these funds are directed to the workers who need the most support, and do a better job of restricting the use of the money to increase workers’ wages rather than paying for overtime or other uses that do not raise the wages of frontline caregivers,” Foley said.

    Kay Lazar can be reached at kay.lazar@globe.com. Follow her on Twitter @GlobeKayLazar.