Washington’s nursing homes struggled with workforce shortages even before the coronavirus. The COVID-19 pandemic is making a bad situation worse, putting patients at risk.

As a recent Seattle Times investigation found, more than half the state’s skilled nursing facilities have been cited by inspectors for insufficient or unqualified staff in recent years. The Times’ analysis of data from the state Department of Social and Health Services revealed nearly three dozen instances of long-term care facilities failing to meet Washington’s direct-care requirements of 3.4 hours per day from July 2018 through December 2019.

These standards are intended to ensure facilities are adequately staffed to protect the health and safety of some of the state’s most vulnerable residents. They should be a minimum, not a goal.

Industry advocates say the problem is twofold: There are not enough nurses and nursing assistants applying for open positions, and not enough money coming in from state Medicaid reimbursements to cover the cost of care. They say the problem has been exacerbated by the global pandemic, which has made care more expensive and staff even more difficult to hire and retain.

By July 26, more than 30% of Washington’s nursing facilities were reporting staffing shortages, according to data from LeadingAge Washington and the Washington Health Care Association, which represent senior-care organizations and skilled nursing facilities.

Washington’s Medicaid reimbursement to long-term care facilities is an estimated $116 million short of the actual cost of care, according to state calculations. Despite a one-time rate adjustment approved by the 2020 Legislature and modest increases in funding during the pandemic, funds are still inadequate, advocates say. Since 2017, at least 24 nursing homes around the state have gone out of business, by their count.


The Department of Social and Health Services is asking state lawmakers to fix the Medicaid shortfall by readjusting reimbursement rates annually to reflect the actual cost of care. Last session, when the state was expecting a budget surplus, Sen. Steve O’Ban, R-University Place, introduced a bill that would have done just that. The bill died in committee. Now that state revenues have plummeted and the surplus is needed, fixing reimbursement rates may be a much harder sell.

But that should not deter the Legislature. Washington’s long-term care facilities should not be allowed to operate when staffing levels are inadequate, but care standards only work if they are attainable. Washington’s vulnerable seniors are counting on policymakers to find a solution and follow through.

Clarification: This editorial, originally published Oct. 22, 2020, was updated on Oct. 23, 2020, to clarify the source of staffing and direct care data.