Need Health Care? Try Craig’s List

Christine Myers, Region 2 Small Business Advocate
Christine Myers, Region 2 Small Business Advocate, mingles with health service professionals from the state of New Jersey  who struggle to fill gaps in labor and comply with regulations.


By Christine Myers, Region 2  Advocate

Recently, more than 30 health services professionals from all over the state of New Jersey gathered to share their experiences, their stories and their frustration with government relations. And they came prepared. The conversation began with CMS 277F700 43.5 Quality of Care – Bed Rails. Beds equipped with bed rails have been standard practice in nursing homes for decades.  They are used to ensure patients do not fall out of bed and hurt themselves.  However with the implementation of that very long ruling in 2017, bed rails went from good to bad, from protecting patients to a form of restraint. Nursing homes were given 8-12 weeks to conform. This was just the beginning…

Every single participant complained about the shortage of qualified nurses, CNAs and aids. “There is a chronic workforce crisis which is impacting the overall quality of care.” The qualified nurses are retiring and they can’t be replaced by just anyone.  The regulations governing nursing homes and healthcare require a sophisticated knowledge of topics including infectious diseases.  “We are losing people who would rather work for the GAP,” stated an attendee. One home health agency relied on attracting qualified nurses from the Philippines, while another relied on workers from Ghana – now the immigration process is too challenging. Unfortunately, getting workers in the U.S. is getting harder by the day and will get even more difficult if the minimum wage goes up.  “An increase in minimum wage will kill the home health business,” stated one attendee.

Home health companies face additional hurdles. They offer live-in or overnight aids, which used to be paid a per diem rate. Now, they must pay their employees by the hour, and after 40 hours of work, they must be paid overtime. This means that after two or three days, they get time and a half.  This drives up the cost of these in-home aids to be unaffordable to virtually everyone. One owner of a home health business said seniors and their family are going to Craig’ to get a home health aid. It is amazing to think that, we are now relying on the same internet marketplace to hire care for our loved ones as we do to search for used furniture.

If a shortage of workers and nurses isn’t enough, add in the training, certification, and regulations and it seems almost impossible to obtain and retain good people. First, future employees must go through training, and in the state of New Jersey, as opposed to other states, there is no on-the-job training, which means they have to be able to afford not to work for this time. But even when they pass their tests, it takes one to three months for the certification, and an agency is not allowed to hire them until their certification is posted on the Board of Nurses. “During this time many of them leave, because they can’t afford to be out of work that long,” said one home health provider. And we are back to the GAP.

“We want some common sense” applied to CMS stated one healthcare consultant with decades of professional experience. The Center for Medicaid and Medicare (CMS) came under a lot of fire during this session.

“It takes years for CMS to come up with long-term regulations, but they only give us eight to 12 weeks to comply,” complained the director of another assisted living agency. In addition CMS regulations require additional reporting, monthly audits and a new payment system all of which burden the already overworked staff.

CMS has a 5-star rating system for quality of care and surveys are calculated into the rating. However, everyone in the room who is affected by these ratings feels they are unfair:  The calculations are baked in and it is not a fair ranking.  One “tag” can mean you lose your preferred provider status, and it is very hard to appeal this process. Meanwhile, loss of your status is serious business when it comes to retaining the confidence of the community you serve. Just as frustrating for the people we met with is the fact that some of the surveyors do not have sufficient medical experience, yet they overstep their bounds and can override the protocol of a doctor or psychiatrist to dispense medication.

The lack of communication between CMS and the Center for Medicaid and Medicare Innovations can cause even more headaches for the staff and impact the care of the patients.

After two hours of very robust and rapid conversation we hadn’t even touched on National Labor Relations Board or Occupational Safety and Health Administration, which also regulate the nursing home and home health industries.

Healthcare is serious business, and serving the needs of our most vulnerable is challenging, at times exhausting, and often rewarding.  How do we tip the scales so that regulations don’t’ make it so challenging, exhausting and expensive that the workers prefer to work an easier job at the GAP and family’s don’t have to search on Craig’s list for caregivers to care for our parents and grandparents?

Christine Myers is the Office of Advocacy’s regional advocate representing New York, New Jersey, Puerto Rico and the U.S. Virgin Islands. Our Regional Advocates in the 10 SBA regions stand ready to hear from you about small business concerns and to help you level the playing field for small businesses in your state.


Assistant Chief Counsels Linwood Rayford and Janis Reyes also attended the meeting with Myers and returned to Washington with their laundry list in which to follow up.