Controversial bill would force nursing homes to raise staff wages
The latest release of AAR3’s Nursing Home CO9I'-1 'ashboard shows that both cases and deaths in nursing homes declined in the four weeks ending March 21. Although these rates are improving, chronic staffing problems in nursing homes²revealed during the CO9I'-1 pandemic²continue. In Rhode Island,
0 of nursing homes reported a shortage of nurses or aides, which is only fractionally better than the previous reporting period.
AAR3 has come out swinging to fight for enhancing the quality of care in Rhode Island’s
104 nursing homes.
AAR3 Rhode Island, representing 1 1 members, calls for the *eneral Assembly to ensure the quality of care for the state’s nursing home through minimum staffing standards, oversight, and access to in-person formal advocates, called long-term care Ombudsmen. The state’s the largest aging advocacy group has urged lawmakers to create a state task force on nursing home quality and safety and has pushed for rejecting immunity and holding facilities accountable when they fail to provide adequate care to residents. It’s also crucial that Rhode Island ensures that increases in nursing homes’ reimbursement rates are spent on staff pay and to improve protections for residents, says AAR3 Rhode Island.
Last 'ecember, AAR3 Rhode Island called on *overnor *ina Raimondo to scrap (xecutive Order 20-21 and its subsequent reauthorizations to grant civil immunity related to CO9I'-1 for nursing homes and other long-term care facilities. The aging advocacy group warned that these facilities should be held responsible for providing the level of quality care that is required of them for which they are being compensated.
'uring the legislative session, the state’s nursing home staffing crisis caught the eye of Senate Majority :hip Maryellen *oodwin is a policy issue that needs to be addressed. They knew that Rhode Island ranked 41st in the nation in the number of the average hours of care nursing home residents receive, according to data from the Centers for Medicare and Medicaid Services. The state also has the lowest average resident-care hours per day of any New (ngland state.
On )eb. 2, the Rode Island Senate approved S 0002, “Nursing Home Staffing and Quality Care Act” sponsored by *oodwin and nine 'emocratic cosponsors to address an ongoing crisis in staffing nursing homes that has been exacerbated by the CO9I'-1 pandemic. The bill had passed unanimously in the Health and Human Services Committee, and ultimately, the full Senate gave its thumbs up to the legislative proposal by a vote of 4 to 4. Only one Republican senator crossed the aisle and voted with the 'emocratic senators.
“There is a resident care crisis in our state. Staffing shortages and low wages lead to seniors and people with disabilities not receiving the care they desperately need. The pandemic, of course, has exponentially increased the demands of the job and exacerbated patients’ needs. :e must confront this problem head-on before our nursing home system collapses,” said Sponsor Senator *oodwin ('-'ist. 1, 3rovidence).
The legislation would establish a minimum standard of 4.1 hours of resident care per day, the federal recommendation for quality care long endorsed by health care experts including the American Nurses Association, the Coalition of *eriatric Nursing Organizations, and the National Consumer 9oice for Quality LongTerm Care. The bill, which the Senate also approved last year, has been backed by Raise the %ar on Resident Care, a coalition of advocates for patient care, and the Rhode Island’s 'epartment of Health (RI'OH).
The bill would also secure funding to raise wages for caregivers to recruit and retain a stable and qualified workforce. Short staffing drives high turnover in nursing homes. Not only does high turnover create undue stress and burnout for remaining staff, but it also diverts valuable resources to recruit, orient, and train new employees and increases reliance on overtime and agency staff. Low wages are a significant driver of the staffing crisis. The median wage for a CNA in Rhode Island is less than 1 , and 1 hour lower than the median wage in both Massachusetts and Connecticut.
The legislation would also invest in needed training and skills enhancement for caregivers to provide care for patients with increasing acuity and complex health care needs.
At press time, the companion bill (2021-H- 012), sponsored by Reps. Scott A. Slater ('-'ist.10, 3rovidence) and :illiam :. O’%rien ('-'ist. 4) was considered by House )inance Committee and recommended for further study.
RI'OH’s 'irector Nicole Alexander-Scott, M', M3H says the state agency “supports the thoughtfulness of the provisions included in the legislation and welcomes dialogue with its sponsors, advocates, and the nursing home facility industry regarding methods to sustain the necessary conditions associated with the intent of the bill.”
Alexander-Scott states that “RI'OH takes its charge seriously to keep nursing home residents and is supportive of efforts to update standards of care to better serve Rhode Islanders in nursing facilities, as well as increase resident and staff satisfaction within nursing facilities.”
)raser, 3resident and C(O of the Rhode Island Health Care Association (RIHCA), a nonprofit group representing 0 percent of Rhode Island’s nursing homes, says that “staffing shortages are directly traceable to the chronic lack of Medicaid funding from past governors. 3eriod.”
According to )raser, state law requires Medicaid to be funded at a national inflation index, usually averaging around
. “Up until this year, previous governors have slashed this amount resulting in millions of dollars in losses to our homes. Thankfully, *overnor Mc.ee is proposing to fully fund the Medicaid Inflation Index this year,” he says.
RIHCA opposes the mandatory minimum staffing the legislation now being considered by the Rhode Island *eneral Assembly, says )raser, warning that its passage would result in facilities closing throughout the state. “No other state has adopted such a high standard,” he says, noting that the :ashington, 'C-based American Health Care Association estimates that this legislation would cost
Rhode Island facilities at least million to meet this standard and the need to hire more than 00 employees.
)raser calls for the “Nursing Home Staffing and Quality Care Act” to be defeated, noting that the legislation does not contain any provisions for funding. “Medically, there is no proof that mandating a certain number of hours of direct care results in any better health outcomes. This is an unfunded legislative mandate. If homes are forced to close, not only would residents be forced to find a new place for their care, but hundreds of workers would also be forced out of work,” he says.
*oodwin does not believe that mandating minimum staffing requirements in nursing homes will force nursing homes to close. She noted that the legislation is aimed at ensuring nursing home residents receive adequate care and that Rhode Island is the only state in the northeast without such a standard.
“There is an un-level playing field in nursing home staffing in Rhode Island,” charges *oodwin, noting that many facilities staff 4.1 hours per day, or close to it, while others only provide two hours of care per day. “In either case, the overwhelming majority of well-staffed and poorly-staffed nursing homes remain highly profitable,” she says.
According to *oodwin, the lack of staffing and certified nursing assistants (CNAs) is due to unreasonable workloads and low pay. “RI'OH’s CAN registry makes it clear that retention of these workers is a big issue. This is in part because they can make as much money ± or more ± in a minimum wage profession with much less stress,” she adds, stressing that “The Nursing Home Staffing and Quality Care Act” directly addresses these staffing challenges.
One quick policy fix is to provide nursing home operators with adequate Medicaid reimbursement to pay for increased staffing. Lawmakers must keep Mc.ee’s proposed increase of nursing home rates pursuant to statute, requiring a market-based increase on Oct. 2021, in the state’s )< 2020 budget. The cost is estimated to be . million.
:ith the House panel recommending that Slater’s companion measure ((2021H012) to be held for further study, *oodwin’s chances of seeing her legislation becoming law dwindles as the Rhode Island Assembly’s summer adjournment begins to loom ever closer. There’s probably no reason to insist that a bill be passed in order to have a study commission, so this could be appointed right away if there is serious intent to solve this problem.
Slater’s legislation may well be resurrected in the final days of the Rhode Island *eneral Assembly, behind the closed doors when “horse-trading” takes place between House and Senate leadership. If this doesn’t occur, either the House or Senate might consider creating a Task )orce, bringing together nursing home operators, health care professionals, and staff officials, to finally resolve the state’s nursing home staffing crisis.