State nurses ready to ditch program after 12 raise-less years Cost-saving program in jeopardy if Olympia lawmakers can’t solve pay problem

Photo: Rachel La Corte, ASSOCIATED PRESS The Department of Social and Health Services had asked that that...

Here’s an easy question.

You have a job. You like it most of the time. You haven’t had a raise in 12 years.

Now you could have this other job, one that is a lot like this job you like. The qualifications are basically the same. The pay was totally stagnant, too, until last year when it jumped way, way up.

So, the question: Do you give yourself a 30 percent raise?

Lawmakers in Olympia are hoping hundreds of Washington’s publicly paid nurses answer “No.”

If they don’t, a Medicaid-supported program that keeps costs down while keeping chronically ill people in their homes could be in serious trouble.

The Department of Social and Health Services had asked that the Legislature deliver a raise for a small group of nurses left out of a court-ordered pay increase. With a budget fight ongoing, though, lawmakers don’t appear ready to come up with the $2 million needed to make up for the $12-an-hour pay disparity.

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The registered nurses whose pay is at issue are known as nurse delegators. They are paid to train caregivers to provide basic medical care to chronically ill Washingtonians who would otherwise require in-home nursing care or be placed in nursing homes.

Hanahn Korman, a registered nurse advocating for better pay for nurse delegators, said she and the other nurse delegators hadn’t expected they would have to push Olympia to keep their pay consistent with their counterparts.

“We, as just people doing our jobs, never thought we would have to fight to get this increase,” Korman said.

Publicly paid nurse delegators last received a raise in 2005. In the same time, pay for Washington legislators has increased 32 percent, to $46,839 annually for the part-time job, while the governor’s pay has increased 17 percent to $173,617.

Nurse delegation came into being as more Americans needed continuing care for illnesses that would previously have killed them. In-home care was preferred by the insurance companies and government insurers as far less expensive, and by patients.

More fragile patients receive care from private-duty nurses, who usually spend their shifts providing care to a single patient. Healthier patients can be served by a nurse delegator.

Nurse delegators monitor a patient while training unskilled caregivers – parents, children or adult family home operators – to provide basic nursing care.

A nurse delegator could train a caregiver for a diabetic person how to inject insulin. If the patient’s condition worsened, the nurse delegator would check up.

About 8,000 patients in Washington currently receive care from nurse delegators paid through the Department of Social and Health Services. Since 2005, when nurse delegators last received a payrate increase, the number of clients has increased 54 percent while the number of nurses has fallen 25 percent.

“I know one nurse who has 92 homes,” Korman said. “I don’t know how she does it. She works hours and hours and hours. Of course, she doesn’t get overtime.”

State-paid nurses who directly care for medically fragile people received a rate increase in 2016. That increase stemmed from a lawsuit on behalf of chronically ill, publicly insured children whose parents couldn’t find nurses willing to work at the state-set rate.

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The court order that pushed that raise didn’t extend to Korman or other nurse delegators, creating a situation in which equally qualified nurses in similar situations are paid at dramatically different rates.

Functionally, both types of nursing service provide the same benefit – they keep patients out of nursing homes and hospitals. Institutional care is far more expensive, drawing from the same coffers currently closed to the state’s 200-or-so nurse delegators.

The nurse delegators are independent contractors with the state paid in a 50-50 split from federal Medicaid dollars and state money. Non-unionized and not represented by any large lobbying organization, they haven’t been able to advocate for themselves.

By Korman’s estimate, a quarter of the state’s nurse delegators may stop taking Department of Social and Health Services clients if the Legislature doesn’t deliver a rate increase. The nurses involved could shift to other nursing work immediately.

Department of Social and Health Services managers requested a $12-an-hour raise for the nurse delegators, but that raise isn’t in budget proposals put forward in the Legislature or by Gov. Jay Inslee.

“That’s not anything to get rich on,” Korman said. “As far as being a nurse, it’s not excessive … but it would get us even with private duty nurses.”

A Department of Social and Health Services budget request outlined the possible harms of a failure to raise reimbursement rates for the nurses.

“The result from the rate increases is that more nurses will be available to meet the increasing demand for in-home and residential services,” program managers said in a memo to the Legislature. “This means that the state will avoid potentially expensive shifts in the client caseload. … The other benefit is that over 8,000 Medicaid clients will continue to have the choice to stay in the home and community settings that they prefer.”

“The alternative is … to continue to lose ground in terms of attracting and retaining nurses,” the memo’s authors continued. “Given the impact to clients and additional costs that would result to the state if capacity continues to erode, a rate increase to match the increase for the private-duty nursing providers seemed more prudent.”

Korman and a handful of other nurse delegators are heading to Olympia later this week in a last-ditch effort to for the pay raise.

Seattlepi.com reporter Levi Pulkkinen can be reached at 206-448-8348 or levipulkkinen@seattlepi.com. Follow Levi on Twitter at twitter.com/levipulk.