Minnesota is transforming its nursing home industry with a model that empowers workers

A bold new law signed by Minnesota Gov. Tim Walz has the potential to dramatically improve the nursing home industry. The new Minnesota Nursing Home Workforce Standards Board Act will bring together workers, employers and government to set minimum workplace standards for the sector, which can address longstanding challenges in the industry.  

Minnesota’s nursing homes have long faced a staffing shortage — leading seniors to struggle to find the care they need — a problem the COVID-19 pandemic exacerbated.  In fact, Minnesota’s nursing home worker shortage is viewed as the worst in the country. In many cases, nursing homes have to leave beds open because they don’t have enough workers to safely take on additional residents.  

Staffing shortages occur because of a compounding series of issues that start with low pay and poor working conditions. Low compensation leads to understaffing, which leads to burnout, which leads to high turnover — creating a vicious circle of overworked and underpaid staff. 

Everyone in the industry recognizes the understaffing problem. Workers supporting the new law certainly do, as does state government and the firms providing care. Indeed, the industry association website states that “Minnesota seniors and their families are waiting for the care they need because there aren’t enough caregivers.”  

Solving this problem will benefit workers, employers, patients and the public.

The nursing home workforce standards board provides a forum to address the industry’s challenges head on. The board will bring together representatives of workers, employers and state government to investigate workforce challenges, discuss solutions, and enact regulations that will “protect the health and welfare of nursing home workers.” The board has authority over multiple, interrelated workplace issues such as compensation and worker health and safety.  

Unlike many commissions, the workforce standards board can set policies with the force of law. The board has rulemaking authority for a broad set of compensation-related matters and can issue recommendations on safety issues. In other words, the board has real, but circumscribed, power. Indeed, the new law requires that the board “must adopt rules” establishing minimum nursing home employment standards and do so every two years.  

This power combined with a governing structure that brings together key stakeholders — giving employers, workers and the government equal representation on the board — makes it possible to have substantive discussions about how to best raise standards and address staffing shortages.  The board will also conduct public hearings and investigations to gain additional insights.

Workers have significant knowledge about working conditions, and a standards board takes advantage of that expertise by giving them as strong a voice as employers.  The board helps empower workers — and empowered workers are essential to ensuring that workers can successfully push for high standards, as well as come forward to report violations and ensure compliance. Workers and their representatives know from their day-to-day experience whether the standards they establish are being upheld, helping improve compliance.

Employers, meanwhile, gain a forum to discuss issues with workers and other firms in their industry, and raising standards across an industry enables them to hire more workers and creates a level playing field for all firms in the industry. This ensures fair competition and makes it more likely that these gains for workers will be sustainable. 

Employers also gain assurance in the law that if the cost of new standards exceeds the forecasted growth of nursing home wage spending, the standards will be on hold until the Legislature appropriates sufficient funding. In that case, the Legislature would know exactly how the additional funding would improve worker wages.  The vast majority of nursing home funding comes from public sources, and because nursing home funding has typically been a bipartisan issue, recommended appropriations seem likely to receive approval.

Minnesota’s bold effort builds on long-standing policies that have been growing in popularity.  

The Minnesota Nursing Home Workforce Standards Board Act follows a model of standard setting that is remaking low-wage work in industries around the country — and the world.  

Indeed, a handful of states — most notably, New York and California — have had similar wage board laws on their books for nearly a century. 

Over the past few years, five states and three local governments have enacted new standards board laws — Michigan (Nursing Home Workforce Stabilization Council); Colorado (Agricultural Work Advisory Committee); Nevada (Home Care Employment Standards Board); California (Fast Food Council); New York state (Farm Laborers Wage Board); Seattle (Domestic Workers Standards Board); Philadelphia (Domestic Workers Standards and Implementation Task Force); and Detroit (Industry Standards Board). 

And within the past year, the European Union, New Zealand and Australia have all passed related sectoral-standard setting policies.

Ultimately, an industry standards board could help build a new participatory model that improves nursing home work in Minnesota and fixes the staffing shortage.