By LAURA WEICK Legislation requiring nursing homes to provide residents a minimum of 4.1 hours of direct care daily has prompted claims it would put the facilities out of business. Meanwhile, the union representing nursing home employees has planned to
Legislation requiring nursing homes to provide residents a minimum of 4.1 hours of direct care daily has prompted claims it would put the facilities out of business.
Meanwhile, the union representing nursing home employees has planned to strike unless nursing homes adopt standards for hours of direct care or lawmakers approve the measure.
The Nursing Home Staffing and Quality Care Act calls for nursing homes to have “sufficient numbers” of nursing personnel, including registered nurses and certified nursing assistants, on a 24-hour basis. Nursing facilities would be required to provide a minimum daily average of 4.1 hours of direct nursing care for each resident.
The House Committee on Finance and Senate Committee on Health and Human Services held hearings on the legislation last week. The House committee held the bill for further study, but the Senate committee approved the legislation for floor consideration on July 16. If passed, the law would go into effect on Oct. 1, 2020.
Meanwhile, the Service Employees International Union (SEIU) plans to strike July 29 because nursing homes have not responded to demands for a mandated number of direct care hours for residents. SEIU organizer and Raise the Bar coordinator Adanjesus Marin said that if this legislation is passed, the union would not strike. The union first presented its list of demands 13 months ago, according to Marin, but the COVID-19 pandemic made the issue even more pressing.
“If you are a resident in a nursing home, you are guaranteed no minimum staffing hours,” Marin said. “You could be there for 24 hours and they could skip giving you any care, there’s no repercussion for that. We are one of only 11 states in the whole country that doesn’t have staffing requirements.”
However, the American Health Care Association (AHCA) estimates more than 750 new employees would be needed at Rhode Island’s nursing homes if the legislation were approved. The estimated cost of this hiring would be $43.9 million, according to the AHCA. This estimate came before the COVID-19 pandemic.
“You can’t find 750 people in the state to fill these roles,” said Scott Fraser, president and CEO of the Rhode Island Health Care Association. “Our homes are always looking for staff, but given the market it’s very difficult to find staff. So to find 700-plus and to pay them would be an incredible burden, especially now with COVID.”
Fraser also fears that nursing homes would close if the legislation is approved.
“Many of our homes are already on financial edge because of lack of state funding,” Fraser said. “To put one more financial burden on top of the pandemic, PPE, current staffing concerns, would break us.”
However, Marin believes that the nursing homes’ financial concerns are unfounded.
“According to their own reports, it shows that in the last two years [the nursing homes] made $241 million,” Marin said. “That’s more than enough to ensure that residents are cared for. And they don’t want more funding to go to workers, they want it to go to their pockets.”
Marin added that if the bill passed, the state would help provide some training and recruitment for nursing home staff.
“The funding for the training would come from the state budget, as would the funding for recruiting and retaining quality caregivers every year,” Marin said. “The bill would ensure that the cost. So the legislation not only takes care of residents guaranteed staffing hours, but it also solves the staffing process by ensuring funding for recruitment for certified caregivers. So many people leave the field because they can make just as much if not more working at Dunkin’ Donuts, and that’s not right.”
Fraser said nursing home staffs are already well trained, so the legislation is unnecessary. Instead, he believes that more state Medicaid funding from nursing homes would be welcome.
“We’re at the tops of the ranks in quality and control, there’s really not much else we can do to improve,” Fraser said. “But the state can fund us properly, restore the full Medicaid funding. It keeps getting cut in the budget. If the legislature would at the very least fund according to the state law Medicaid index, it would help.”
Fraser also said that some patients might not need the 4.1 hours of direct care that the bill suggests, and argues that different patients have different needs.
“More than 50 percent of our residents have some sort of dementia or Alzheimer’s,” Fraser said. “Those folks may not need as much direct care as those with more physical issues. You’d add on care to people who don’t need it as much.”
Co-sponsors of the legislation argue that Fraser and other critics are missing the purpose of the legislation. Rep. David Bennett of Warwick, a co-sponsor of the House bill, said that every nursing home resident should be treated with respect, especially those who may not have family or friends to visit.
“You have to be treated like you're human, not just cattle,” Bennett said. “The only way you get that human touch is through eye contact, listening, giving them time. These people are people, someone's mother, someone's brother.”
Fraser sees it differently.
“They get the human touch every day,” Fraser said. “One thing left out of the narrative when visitations stopped during the pandemic. They were like, ‘There’s no one with them!’ But our staff was in there every single day, talking to them, feeding them, cheering them up, planning activities.”