Senators approve nursing home bill

Governor to sign staff-rule overhaul

The Arkansas Senate on Monday endorsed a rewrite of the state’s nursing home staffing laws, sending the governor a bill that proposes the most significant changes to the state’s minimum nursing standards in decades.

House Bill 1776, which drew opposition from nursing home residents’ advocates last week, cleared the Senate with 32 of 35 senators voting in favor. The Senate vote was the fourth public approval of HB1776, as the bill was advanced by two committees and both legislative chambers without eliciting a single public question from a lawmaker.

In a statement provided by his spokeswoman, Gov. Asa Hutchinson said late Monday that he will sign the bill into law.

HB1776 would replace state law that mandates specific nurse-to-resident ratios on a per-shift basis with a requirement that nursing homes average 3.36 “direct care hours per resident day” over a one-month period.

It would allow nursing

homes to count medication assistants and therapists as “direct care staff.” The current laws explicitly excludes the two categories of workers.

Financial penalties for nursing homes found to have a pattern of violating state staffing laws would be repealed.

“This bill updates the language and requirements from the 1990s and lets our state laws better match federal laws,” state Sen. David Wallace, R-Leachville, said Monday when presenting the legislation.

Other supporters have said HB1776’s classification of medication assistants and therapists as “direct care staff” matches federal regulations. They have argued that the 3.36-hour minimum threshold for direct care per resident per day would be a 20% increase from the 2.8 hours per resident per day to which the current laws equate.

Residents’ advocates who opposed the bill said staffing levels are the most important measure to determine quality of care at nursing homes. Expanding the definition of direct care will dilute the quality, they argued.

Directors at AARP Arkansas and Arkansas Advocates for Nursing Home Residents opposed the bill, they said in interviews last week. Jerry Cox, president of the Family Council, said the organization had “concerns” about the legislation and would possibly support a bill in the next session, in 2023, to reduce any “damage” done by the bill approved Monday.

Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, said Monday that the bill’s passage was “inevitable.” Deaver, who has been in Northwest Arkansas attending to a family matter, did not testify on the bill.

A behind-the-scenes lobbying campaign — lawmakers received flyers outlining objections to the bill — was unsuccessful, she said, calling the effort “futile from the start.”

“We’re talking about residents who — a lot of them can’t move,” Deaver said. “They have to be turned. They have to be fed. When that doesn’t happen, the outcome is neglect and abuse. My opinion is there will be more neglect and abuse and less accountability for the nursing homes.”

Richard Mollot, who runs the New York-based nonprofit Long Term Care Community Coalition, said he felt the bill’s authors misunderstood federal regulations.

The national rules, he said, generally set a good foundation, but they are best when state laws are built atop them.

Federal rules require that staffing be “sufficient” to meet individual residents’ needs. They also set a bare-minimum requirement for registered nurse hours, but that minimum is uniform and doesn’t consider a facility’s size.

Staffing ratios are left up to states — roughly 40 supplement federal regulations with specific nursing home staffing laws, Mollot said.

The current Arkansas laws, which would be repealed under HB1776, specify how many direct-care staff members need to be on duty for every resident at varying times of the day.

The overnight shift requires one direct-care staffer for every 14 residents, for example, while the day shift requires one direct-care staffer for every six residents.

A March report from the U.S. Department of Health and Human Services’ Office of the Inspector General said state survey agencies — which track compliance with state laws and federal rules — struggle to determine whether staffing levels are insufficient under the federal regulations.

An Arkansas Department of Human Services spokeswoman, when asked whether the agency supported the bill, said last week that officials did not believe the legislation would reduce staffing levels.

Wallace characterized the agency, whose Office of Long-Term Care is Arkansas’ state survey agency, as “neutral.”

The Arkansas Health Care Association, which mostly represents nursing homes, helped write the bill, Executive Director Rachel Bunch said. Bunch has said “there is much work to be done” in terms of the official state rules that need to be created through the measure.

Sens. Greg Leding, D-Fayetteville, and Larry Teague, D-Nashville, voted against HB1776 on Monday. Sen. Joyce Elliott, D-Little Rock, voted “present.”

Leding and Teague joined House Rep. Denise Garner, D-Fayetteville, as the only lawmakers to vote against the legislation.

No one stated a specific reason for opposition or asked questions of the bill’s sponsors.

Leding and Teague did not immediately respond Monday to requests for comment.