The red lights are flashing in our health care system

HELP DESPERATELY WANTED — Health care is recovering unevenly from the pandemic. Eldercare and care for the disabled are among the hardest hit. How bad is it? The number of nursing home employees dropped from 1.5 million in February 2020 to 1.3 million in December 2022 — a level not seen since 1994.

And it’s not just nursing homes that are precariously short-staffed. Community adult day programs. Home care. Assisted living. Even hospice.

Care for our most fragile and vulnerable — an essential social good — is in the midst of a years-long crisis. That has ripple effects throughout health care.

When LeadingAge, the trade association for nonprofit aging providers, did a snap poll of its members recently, they all reported that worker shortages are just as challenging now as they were a year ago, when the pandemic was far worse. They don’t have enough workers. And they don’t retain workers; turnover is very, very high.

Ruth Katz, the organization’s vice president for policy, told Nightly that the only long-term care provider she’s come across recently that doesn’t have a staffing crisis was a nursing home run entirely by Mennonite volunteers.

Some nursing homes aren’t even filling all their beds, because they don’t have enough people to provide care. “They aren’t even keeping waiting lists,” Katz said.

Elder care is hard. It requires patience. It requires attention to detail. It is physically difficult and includes lots of lifting and moving. Those who take care of the elderly are not well-paid. One woman I spoke to recently in Texas said the aide who helps her mom, a stroke victim with dementia, makes “about what I made per hour part-time in high school.”

Much of the burden falls on families — some 53 million Americans are family caregivers. Many give up paid jobs, or downshift to part-time. The squeeze from the professional workforce shortage only makes the family tasks bigger.

Right now, several factors are making the care workforce shortage even more acute. In the overall U.S. economy, there are around 1.7 jobs open for every one person looking, meaning people who might have worked as caregivers now have other options, with better pay.

To attract or retain workers, a retail chain or a fast food joint can add a few pennies to the price of Band-Aids or burgers. In fact, that’s exactly what they are doing, one contributor to the inflation we’re experiencing. But much of elder care — whether long-term care or shorter-term rehab and recovery — is paid by Medicaid and Medicare, and the government sets the rates. Congress is utterly disinterested in spending more on health at the moment.

Another potential solution is giving special visas to more nurses or other caregivers to enter the country. A recent study for the National Bureau of Economic Research, co-authored by Harvard’s David Grabowski, one of the top experts on nursing homes, found that immigration has “a very positive effect” in nursing homes. Patients get more care, and they get better care. Katz also noted that many elder care workers are already foreign born. But pretty much anything to do with immigration is a nonstarter on Capitol Hill.

Soon, the problem might get more complicated. The Center for Medicare and Medicaid Services, which has stepped up oversight after Covid infections tore through nursing homes, plans to release nursing home staffing requirements this spring — which some in the industry say will just make matters worse. In the process, CMS has heard from relatives of people in nursing homes who “voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities.” Families reported that their loved ones go entire shifts without even the most basic assistance, like help getting to the bathroom. That leads to falls, when fragile people try to get up themselves, or to hard-to-heal pressure ulcers — aka bed sores — if they are left lying in one position for too long.

For Katz, the workforce crisis is the flashing red light signaling that we just aren’t facing up to the demographics of an aging America. That requires a culture shift, she said, respecting the hard work caregiving entails as well as better understanding our elders.

“Whether you are working in a department store or Disneyland,” she said, “you are going to need to know how to deal with older people.”

Welcome to POLITICO Nightly. Reach out with news, tips and ideas at [email protected]. Or contact tonight’s author on Twitter at @JoanneKenen.

— FBI makes arrest in investigation of suspected leaker of classified intelligence: The FBI said it has made an arrest and is conducting a search of a home at a residence in Massachusetts, according to a statement by the agency. It appears to be the home of the mother of the suspected leaker of the classified documents that have circulated on social media in recent days. The home is located in North Dighton, Massachusetts, the FBI said — the same town where the potential leaker and his mother live, according to a review of public records by POLITICO. The New York Times was the first to report that the leaker is likely Jack Teixeira, 21, a member of the Massachusetts Air National Guard.

— Appeals court keeps abortion pill on the market but sharply limits access: A federal appeals court ruled late Wednesday that an abortion pill can remain on the market but only under strict conditions that prohibit its use beyond seven weeks of pregnancy and bar its distribution by mail. In a 42-page decision, a three-judge panel of the 5th Circuit Court of Appeals agreed to temporarily block the central aspect of a Texas-based federal judge’s ruling that suspended the FDA’s 2000 approval of the drug, mifepristone. But by a 2-1 vote, the panel permitted other aspects of that ruling to take effect that would block a seven-year effort by the FDA to widen access to the drug.

— Capitol Police officer who sought to protect Jan. 6 rioter sentenced to home incarceration: A Capitol Police officer who tried to help a Jan. 6 rioter avoid detection from law enforcement was sentenced today to 120 days of home incarceration for obstructing justice. Michael Riley, a decorated 25-year veteran of the Capitol Police who was one of the first officers to respond to pipe bombs found at the RNC and DNC on Jan. 6, delivered a tearful apology in the courtroom, describing “awful judgment” in the days following the attack that led him to attempt to aid a member of the mob.

MYSTERY MAN — Sen.Tim Scott (R-S.C), who announced an exploratory committee on Wednesday, remains a mysterious factor in the Republican primary field, reports POLITICO’s Natalie Allison. Donors float him as a potential alternative to Donald Trump, should Florida Gov. Ron DeSantis stumble. And Scott’s genteel personality and lack of past Trump entanglements could give him unique appeal to independents and a newer swath of GOP voters. A foregone conclusion, though, is that evangelicals — with all their subsets and denominations — will be his top constituency.

TRIPPED UP — Tim Scott has quickly discovered how tricky abortion politics can be when forced to discuss them on the national stage. POLITICO’s Natalie Allison and Lisa Kashinsky write. On his second day of campaigning since announcing a presidential exploratory committee, the South Carolina Republican senator pivoted, deflected and avoided specifics when repeatedly pressed on where he stood on federal abortion restrictions.

THE BOT PRIMARY — Coordinated groups of inauthentic accounts have been attempting to influence online conversations around the 2024 elections for the better part of a year, reports ABC News. According to the Israel-based, social analysis firm Cyabra, someone created thousands of automated Twitter accounts that appear to be praising Trump and criticizing his political rivals on both sides of the aisle.

ORGANIZING WITHOUT BORDERS — Luiz Inácio Lula da Silva arrived in Washington earlier this year in the glow of a glorious comeback, writes Alexander Burns. Freed from prison, elected to a new term as president of Brazil and triumphant over a Jan. 6-style insurrection, the left-wing populist seemed to embody the endurance of democracy in an era of extremism.

But in private meetings with progressive lawmakers and labor leaders, Lula delivered a dire message, according to four people present for the discussions.

Though poisonous demagogues had fallen in both Brazil and the United States, Lula warned that a global web of right-wing forces continued to threaten political freedom. Voters crushed by economic inequality and confused by a torrent of social-media disinformation remained vulnerable to figures like Donald Trump and Jair Bolsonaro, the brutish strongman whom Lula barely defeated last fall.

In Washington, the 77-year-old Brazilian leader issued a call to battle: The left needed to build its own transnational network, Lula said, to fight for its political values and take on crises like economic deprivation and climate change.

In Lula’s meeting with congressional progressives, Rep. Ro Khanna (D-Calif.) said Lula described a certain form of progressive politics — focused on economic advancement for the working class and fighting climate change — as the antidote to a mood of despair that feeds authoritarian politics.

“One of the interesting insights he had was that there was a movement, not just in Brazil but around the world, of anti-politics,” Khanna said, “and that people have so lost faith in organizing and political activity, they have bought into the narrative that everything is corrupt, everything is broken and politics doesn’t matter.”

A DIFFERENT KIND OF HOME — Across England, increasingly more people are moving into caravans — essentially mobile homes or trailers. In 2021, there were 104,000 households in caravans officially — 19,000 more than a decade ago. For some people, it offers flexibility not present when renting a home. But far from everyone lives in caravans by choice; a roiling housing crisis in England has made it difficult to afford or stay in homes. Daniel Lavelle takes us inside these caravan parks for The Guardian, speaking to residents and painting a picture of why people end up in caravans and the challenges associated with living in one.

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