The State of Nursing Homes in Rhode Island

An inside account of the need for more state support

Certified Nursing Assistant Dawn Auclair has worked at Hopkins Manor Nursing Home in North Providence for 21 years. She managed to balance raising five kids and her career, working tirelessly to support residents at the ends of their lives. Throughout her time at Hopkins she has never experienced anything like she did in early March, when the pandemic wreaked havoc on her workplace and life. Auclair, a delegate for the Service Employees International Union (SEIU), shared her experience fighting for fair working conditions, increased wages, and better staffing ratios in a phone interview with the College Hill Independent. She stressed that the pandemic didn’t create a lack of state support, but rather revealed pre-existing difficulties that workers have felt for a long time, particularly in nursing homes that aren’t affiliated with her union. Auclair speaks for many Certified Nursing Assistants (CNAs) who are hoping for unified, long-term support from the governor and legislature. In the interview, she shared her thoughts about the strikes that have been and are still being organized around facilities during the pandemic and her current work to pass a bill that would give residents and workers the support they deserve.

NS: What does a typical day look like for you? How many hours do you work? How many patients do you see? What are your basic tasks?

DA: I’m only working 37.5 hours a week right now, though I usually pick up overtime shifts. A typical shift for me starts with patient care. I go in, get my patients up, wash and shower them, feed them their meals, and put them back to bed as needed during the day. I attend to whatever basic needs they have: fingernails, toilet trips, etc. If there are more workers, I can spend more time with each resident.

NS: Talk to me a little about staffing. How did COVID affect staff numbers at Hopkins?

DA: Nursing home staffing is a big problem for Rhode Island and the nation, and COVID only exacerbated it. During the first stage of the pandemic, we had a lot of staff leave. We were horribly short, with a ratio of 46 residents to three Certified Nursing Assistants (CNA). Our staff was either in fear, ill, or taking furloughs.

NS: I can’t imagine how hard that must have been. What was it like when COVID hit?

We lost a lot of residents in what felt like a blink of an eye. I’ve seen flu and I’ve seen a lot of viruses go through this facility, but never taking the lives of our residents as fast as this. Our numbers fell from 170 to 120. Between families taking their folks home and the COVID deaths themselves, we’ve experienced a lot of loss. Luckily nothing serious has happened to any of the staff, but it has of course affected the building in a lot of ways.

NS: Did you ever feel like your life or the lives of others were put at risk?

DA: Our lives were definitely put at risk. I have asthma and Chronic Lymphoproliferative Disorder (CLPD), and many of our staff have immuno-compromising illnesses. At the beginning of the pandemic, I was scared to get up and go to work every day. I knew that I was putting my life on the line, and I just kept praying that I wouldn’t get sick. When our facility got infected, COVID blew through the rooms like a fire. Somehow, from the beginning until now I’ve stayed negative, which is a miracle. And I’ve recently been vaccinated so I’m not as scared. But those beginning few months were terrifying. CNAs had a lot of weight on their shoulders.

NS: How has your management responded?

DA: Right now, we’re going through a management change, but it’s generally been positive. Their biggest priority is trying to push the vaccine. A lot of workers have gotten it, and 80-90% of our residents have gotten it, too. I’ve seen a big difference from that first surge last year, and a lot of it has to do with the vaccine. We’re just not bagging bodies like we were before.

NS: As a union delegate, what are you doing now to help improve the situation? Have nursing homes in your union been striking?

DA: Though my facility never went on strike, five nursing homes out of the six in our union did go on a three day strike early on in the pandemic. As a delegate, we’ve been working on a bill called The Nursing Home Staffing and Quality Care Act, which we’ve been trying to get passed [in Rhode Island] for almost two years. It would give our residents the quality care that they deserve. There are a lot of nursing homes that aren’t union-organized and are being taken advantage of by their owners. Owners will short-staff workers, and they won’t get compensated for it. If we can get this bill passed, all facilities will be held accountable for staffing their facilities, not just union-affiliated ones.

NS: Why don’t more nursing homes join the union?

DA: Right now, homes will keep staff numbers low to put more money in their pockets. Unfortunately, corporations are buying nursing homes all over the state of Rhode Island. Nursing homes need to be organized, but it isn’t easy to do so because a lot of facilities run constant anti-union campaigns. Healthcare workers need to just pick up the phone and call the union. They need to find leaders and get a vote started.

NS: How did being a part of the union affect your life?

DA: I raised five kids. I was by myself, working this little job, and if I wasn’t working for a union facility, I wouldn’t have been able to give my kids the good health insurance they received. I wouldn’t have had any stability. There are so many more benefits to working for a union-facility than a non-union facility. You have the ability to negotiate your wages. You have the ability to negotiate your health. You have the ability to negotiate your vacation. It’s everything. I have affordable insurance and I’ve been able to give my kids jobs.

NS: In what ways does the state support nursing homes?

DA: When it comes to Medicaid cuts, the state doesn’t seem to care about the elderly society. When cuts are made, my wages are cut, too. I only make $16.35 an hour and I’ve been working at Hopkins for 21 years. I’m clearly not there for the money, but I do feel that our elderly folks work hard their whole lives and they deserve every ounce of quality care they can get. It feels like most nursing home owners don’t want to give it. So now, we’re battling. The [Staffing and Quality Cares Act] bill passed the [RI State] Senate almost unanimously, and we’re waiting for a response from the [RI] House. It didn’t pass the House last year, but COVID has illuminated a lot of inequality, so I’m hopeful.

NS: What happened at other facilities that went on strike? What were preliminary conversations like? What was the process for facilities to prepare for strikes?

DA: It was intense. There were people who were afraid to strike, who were worried about their residents inside. There’s a lot of work involved in organizing a strike. It’s tough and it’s scary. As far as preparing for it, there’s a ten-day notice that goes out to the facility, to let family members know. It’s a big job to cover a strike, and so we have a big job on our end to uphold it.

NS: What was the general response to the strike at the beginning of the pandemic? From government officials? From residents? From family members of residents?

DA: The governor asked us not to strike early on, though she [Gina Raimondo] did endorse the bill. And we’ve received a lot of support inside the State House. Residents supported the strike, too. As much as they didn’t want to see someone else take care of them, they wanted us to receive the resources we need. Families of residents supported us, too. They all know that we care about our work. If we didn’t care about our residents, we wouldn’t be in the facility for over twenty years. Nobody wants to go on strike, but if we need to fight for better wages and better staffing, then that’s what we’re going to have to do. It ultimately will help the residents, and it will help people like you and me when we get older and need that care.

NS: What was the intended effect of the strike?

DA: We had to let the public know what was happening to us and to our elderly. That was the bottom line. Workers were letting people know that their ownership wasn’t meeting their needs. They were on that strike line every shift they were supposed to be working. It sent a powerful message.

NS: What has been done to improve care? How have conversations changed now?

DA: The only thing we’ve gotten from the government is pandemic money. I do get hazard pay. But with COVID and the strikes, the conversation did change. Before the pandemic, nobody cared [about] what we did, everybody thought we just had bad and slummy jobs. Before, they couldn’t give us a 50 cent raise, and now all of a sudden we were getting five dollars extra an hour. After the pandemic hit nursing homes, people began to see just how difficult it is to contain something like this, especially when you’re short-staffed.

NS: Do you think the attitude shift will continue after the pandemic?

DA: Honestly, I don’t. I think we’ll go back to our chump change again. If my facility becomes COVID-free, we’ll no longer receive hazard pay. And I’m sure staffing will go down because people won’t be making extra money.

NS: What’s the state of nursing homes right now?

DA: We’re 42nd in this country for the worst care given. That’s pathetic. We have 89 nursing homes and only six are in my union. Another problem is that young people aren’t signing up for this job right now. If we can’t get workers, staffing will continue to be a problem. We take care of one of our most vulnerable societies that deserve to get the best care they can get. And when corporations are buying our nursing homes, they’re doing it for real estate. They don’t care about workers or the elderly; they buy property to make money. Any way they can put it in their pocket, they will.

NS: Do you think your facility will strike in the foreseeable future?

DA: We don’t know where we’re going to land. Since we’re under new ownership, we have a lot at stake. We haven’t had a strike vote yet since we’re still in the middle of negotiating a new contract. But I do believe we will have to sometime soon, especially if the bill doesn’t pass.

NS: At the end of it all, what’s your favorite part of the job? What keeps you going from day to day?

DA: I love seeing my residents every day. I love to help people and I love the elderly. I believe people at the end of their lives should be safe, comfortable, and well taken care of. But in order to best do that, we need support from the state.

NS: Thank you so much for your time, Dawn. Any last words?

DA: I just want to add that we’re the only state in New England that doesn’t have a staffing ratio for nursing homes. Corporations profit millions off of nursing homes. What are they doing with the money? As a CNA, it’s such an insult that they won’t give us the resources to ensure our elderly are cared for. We tell legislators constantly that they will be old one day and might need this service. And if it’s not you, it’ll be somebody you know.