When COVID-19 first tore through our nursing homes five years ago, I’ll never forget seeing the photo Shanrika Nelson, a certified nursing assistant and union member from Philadelphia, posted online. She wanted the public to see the makeshift PPE that she and her coworkers wore every day to protect their residents and themselves the best they could: a trash bag over her body.

Led by caregivers’ hard work and advocacy, we have made progress since the pandemic to fix and transform Pennsylvania’s nursing home system. But now we are facing a new existential threat – potential – Medicaid cuts that will topple nursing homes still hanging by a thread.

A new study shows that any cuts to Medicaid could lead to double the number of Pennsylvanians without health insurance. Not only does Medicaid provide comprehensive health and longterm care to 3 million residents in our Commonwealth, it funds over 60% of our nursing homes.

I do not want to think about the future of our nursing homes without Medicaid. They likely won’t have one.

Our system is already unprepared for the number of Pennsylvanians growing older quickly. Talk to any nursing home worker: residents are arriving at facilities younger and with more demanding needs. High acuity, higher severity, and more psychiatric conditions. People are coming to our nursing homes sicker. It’s often because they did not have access to high-quality, affordable health insurance and have had undiagnosed conditions for years.

Rated one of the deadliest jobs in 2020, nursing homes saw caregivers leave for better-paying, less-dangerous, and less-stressful jobs. Those who stayed often work overtime or second jobs to pay the bills and cover their own medical debt. We fought for and won staffing ratios to ensure every resident receives quality care, but operators are still struggling to retain and recruit the skilled workforce needed.

Simply put: we do not have the beds, workers, and training needed to care for Pennsylvanians in the immediate future. And proposed Medicaid cuts are putting nursing homes in danger now.

April Chirdon, a CNA who’s worked at the same facility in Cambria County for 17 years, is especially worried about rural nursing homes like hers. Much like in other rural communities, an overwhelming majority of her residents depend on Medicaid. It covers the cost of their care, from their caregivers’ wages and benefits to the food they eat and lifesaving equipment like nebulizers and oxygen tanks. They don’t have an alternative to this care: their families cannot afford to take care of them at home, or they don’t have any family. If homes like April’s are forced to shut down, where will all of the residents go?

We need more funding, not less. We need more accountability, reforms, and teamwork to make every nursing home a fully staffed, safe, and dignified one.

This system already relies on caregivers to buy supplies like toilet paper, shampoo, hand sanitizer, and favorite food items for residents out of their own pockets. Because the people in these homes are like family to them.

This year, 7,000 nursing home workers have committed to use the power of their union negotiations for new contracts to show the public how much our communities rely on Medicaid, ensure public funding goes to care, and work with responsible operators to defend the resources we need to elevate care for all Pennsylvanians.

Healthcare workers will never forget the pandemic and neither should we. Covid-19 showed us how important it is to listen to frontline caregivers sounding the alarm and protecting our loved ones.

We need to listen to healthcare workers who are calling on Congress to defend Medicaid. We must stand up to these brutal cuts to our communities and our most vulnerable. Medicaid is a lifeline for so many Pennsylvanians and we – legislators, providers, community members, and workers – must protect it.

(Matthew Yarnell is president of SEIU Healthcare Pennsylvania, a union of healthcare workers in Pennsylvania, including over 8,000 nursing home workers. Yarnell was a certified nursing assistant in a long-term care facility and lives in Centre County.)