Lawmakers and staff flag low pay, staffing mix and rate incentives as barriers to moving Vermonters from nursing homes to home care

At a midday debrief, members of the group discussed barriers to shifting Vermonters from skilled nursing facilities into residential or home‑and‑community‑based care, highlighting workforce shortages, compensation and data gaps as primary obstacles.

The meeting focused on whether residents recovering in nursing‑home rehab can move to residential care or return home with supports and what prevents those transitions. The speaker who opened the session asked staff for more detailed counts of actual worker shortages by credential and raised concerns that system incentives favor institutional care over lower‑cost home‑based services.

Why it matters: Moving people down the continuum of care can reduce costs and better match most patients’ preferences to remain in their homes and communities. Participants said that without stronger attention to home‑and‑community‑based supports and better workforce policies, transitions will remain limited.

Key points and quotes

• Low pay and benefits for direct caregivers: The group said direct‑care staff paid through ARIS “are not even offering $20 an hour” and often lack health insurance. A speaker described the combined paid‑time‑off policy as difficult to use and said workers can lose accrued leave when a client dies, a condition that undermines retention.

• Funding and incentives: Members noted substantial public spending to sustain skilled nursing facilities while arguing that the current rate‑setting system can create “perverse incentives” because higher contracted costs feed into higher rebased rates for providers. That dynamic, they said, may reward organizations’ costs rather than raise front‑line caregiver pay.

• Workforce composition and travel nurses: Attendees raised alarm that many contracted nurses and aides travel long distances—industry practice often treats staff driving 50 miles or more as “travelers,” a designation that increases employer costs. One participant said many contracted staff live more than 50 miles away, which raises costs threefold for organizations without necessarily increasing pay for direct caregivers.

• Data and reporting gaps: The group requested clearer breakdowns of staffing shortages by credential (RNs, LPNs, LNAs) so targeted training and recruitment—such as funding a six‑week LNA course—could be considered. Participants said vacancy and occupancy information is available in reports but that the underlying site (referred to as Dale) and spreadsheets are difficult to navigate and do not consistently show vacancy counts month to month.

• Examples and next steps: Central Vermont Hospital’s in‑house curriculum to advance staff into RN roles was cited as a model. The group invited Helen Leen to present union survey data and other evidence at a follow‑up meeting. Participants agreed not to take formal action this year but to gather the requested data and reconsider whether some Emergency Financial Relief (EFR) funding should be used proactively for workforce development.

Claims and disputes

• Claim: Direct‑care workers paid through ARIS are offered less than $20 an hour and lack health insurance; accrual rules for paid time off can penalize caregivers when a client dies. Status: raised in discussion; no formal response recorded in the meeting.

• Claim: The rate‑setting and rebasing process can incentivize organizations to rely on higher‑cost contracted staff, increasing public spending without addressing caregiver pay. Status: asserted in discussion and identified as a possible policy problem; no formal conclusion reached.

What the group will do next: Members asked staff for a credentialed staffing breakdown, invited Helen Leen to present union survey data, and noted upcoming floor business (an amendment to 657 and other bills to be offered by Representative Arsenal and Representative Steady). No motions or votes were taken during the debrief.