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The thousands of aides who prepare food, clean rooms, and do laundry at about 400 nursing homes across Massachusetts are grossly underpaid. Many earn as little as $11 an hour. So there was reason to cheer late last month when Governor Charlie Baker reversed his earlier decision to exclude those and other support-staff employees from a share of a $35.5 million “wage add-on” inserted into the state budget specifically to benefit nursing home workers at the low end of the salary scale. But the governor’s change of heart — which came under pressure from local 1199SEIU United Healthcare Workers East and health care industry advocates — didn’t entirely settle the matter.

For starters, no one seems to know how many workers actually will receive additional money, or how much they'll get. The lack of clarity is unacceptable at this stage — the add-on funding is retroactive to Oct. 1, and raises are supposed to start showing up in paychecks by next month. According to the state, nursing homes will receive a portion of the total allocation based largely on their size. It's up to administrators at each home to determine who receives what. In all, nearly 60,000 workers are eligible to receive payments — including better-compensated staffers such as registered nurses and licensed practical nurses — but there's no formula to dictate how the money should be distributed.

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Besides, $35.5 million may look reasonably good on paper, but will it make a meaningful difference? There is reason to believe that the employees who most need extra cash might reap very little, or nothing at all. The Massachusetts Senior Care Association, an industry trade group, estimates the average payout for each nursing home at $90,000. That's not a lot to divvy up among dozens of staffers. In addition, an undetermined number of nursing homes contract with outside vendors to provide services such as housekeeping — those workers won't be able to collect anything. Nursing homes are required to detail how they spend the add-on money, so it will eventually become apparent whether the additional funding amounted to anything more than a feel-good measure. By then, however, it will be too late to change anything.

A spokeswoman for the Senior Care group called the supplemental funding "the first critical step in putting nursing home staff on a pathway to a living wage." Perhaps — if there is follow-through by the governor and the Legislature. The poor pay and labor-intensive nature of low-level nursing home jobs make employee retention a serious problem, and not just for the workers. A Senior Care survey found that 30 percent of newly hired nursing aides don't last more than a year on the job. That constant turnover takes its toll on elderly residents. "When you think about providing care in a nursing home, clearly that includes the housekeeping, laundry, the activities," says state Senator Karen E. Spilka, an Ashland Democrat who chairs the Ways and Means Committee. "All of that is necessary for the health of residents."

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Keeping these key positions filled will require a comprehensive and sustained effort to improve compensation — not a token one-time pay raise. That should be one of the main topics discussed at an Oct. 31 Executive Office of Health and Human Services public hearing on the add-on pay regulations. The state agency also is accepting comments via e-mail, at ehs-regulations@state.ma.us. The add-on funding has called attention to the financial plight of nursing aides. Now it's time to offer them more substantial help.