President Joe Biden last week rolled out an ambitious set of proposals to improve the quality of America’s nursing homes. The plan, released in advance of the State of the Union address, promises to increase federal staff ratio requirements, tighten infection control and take other measures to improve conditions in the places that have borne the brunt of the COVID-19 pandemic. 

The proposed reforms would affect not just the residents of nursing homes, but also the staff workers — the majority of whom are women, disproportionately women of color — who have kept these centers running through unprecedented times. 

April Verrett is president of Service Employees International Union Local 2015, the largest long-term care union in the country, representing both nursing home and home care workers. She praised the plan as a “game-changing proposal” but also highlighted how much work it has taken to push for change. 

“It’s a direct response to the relentless organizing by these workers, predominantly Black women, who have been on the front lines,” Verrett said. “These workers have been calling for dignity for themselves and their residents,” she said. 

The proposals are wide ranging and vary in specificity. For example, a proposal to “explore ways to accelerate” phasing out shared rooms lacks a proposed pathway. Many goals would require an act of Congress, such as the proposal to increase spending on nursing home inspection and enforcement. However, some could be implemented by the Biden administration unilaterally through rule making and regulatory changes. 

In particular, Verrett praised the Biden administration’s move to establish a federal nursing home staffing minimum. Currently, there is no federal minimum for the ratio of nursing home staffers per resident. Individual states have their own standards, but those vary considerably. More staff per resident — and, by extension, more time spent with individual people — has long been linked to better outcomes for nursing home residents.

Improved staff ratios are one of the biggest needs workers face. “I have not had a conversation with nursing home workers that did not involve staffing. There’s never enough people to get the job done,” Verrett said. 

Adelina Ramos, a certified nursing assistant working in Rhode Island, has worked in nursing homes for the past 12 years and, through her union, has done advocacy around staffing levels for the past five. While things have always been difficult for workers like her, the pandemic made things much worse, she said. 

“A lot of [certified nursing assistants] left the field completely,” Ramos said. 

According to the Kaiser Family Foundation, nursing homes and assisted living facilities have lost over 250,000 jobs since the start of the pandemic. While staffing shortages have always been a problem in long-term care, experts have described the current staffing situation at nursing homes as a “crisis on steroids.” 

Over the course of the pandemic, she lost many of her residents and one coworker to COVID-19. When her residents died, she and other staff members were responsible for putting them into body bags. The funeral home employees refused because they did not have adequate personal protective equipment. 

Ramos works in memory care, and her patients tend to be medically fragile and need a high degree of support. They may not be able to eat, drink or get out of bed on their own.

The fewer staff members on per shift, the less time she has to deliver critical, necessary care. And the less time she has to connect with residents as people. 

“You don’t even get time to talk to [residents],” Ramos said. “They want someone to talk to. Some of them don’t have family that comes and visits them. And a lot of times [because of understaffing] we don’t have time for them,” she said. 

Ramos thought about quitting, too.  

“Obviously, it came across my mind. But I thought about how because of pandemic restrictions, a lot of [residents] couldn’t be with their families,” she said. “Family couldn’t come sit with them and talk with them. We’re the only family they have right now. They need us.”