‘If this were to pass, our homes would have to come up with millions of dollars. Where does that money come from? Does the money come from food? Building repairs?’”

Scott Fraser, CEO, Rhode Island Health Care Association

On Dec. 16, Gov. Gina Raimondo announced that the Department of Health is drafting emergency regulation on minimum staff-to-patient ratios in nursing homes, without legislative approval.

While the plan is still being finalized, spokesman Joseph Wendelken from the Department of Health said in a statement the regulations would require “3.8 staff hours per resident per day” for nurses, CNAs, and other direct care workers.

The 3.8-hour rule the health department is working on is lower than the labor-backed bill, the Nursing Home Staffing and Quality Care Act, brought before the legislature in July, which would have required 4.1 hours per resident per day. Out of the 80 nursing homes in Rhode Island, an estimated 57 facilities do not currently meet this standard.

“Regulations like these would bring more structure and consistency to the resident-to-worker hours ratio across Rhode Island. They would also ensure that workers have adequate support. We have seen throughout this pandemic how taxed that frontline workers are at these facilities,” Wendelken said.

There is no implementation date set, as the health department is still working through the details.

Scott Fraser, CEO of Rhode Island Health Care Association, says he’s concerned about the potential mandate.

“We’re not sure where the number came from or why it’s being proposed. There’s no proof that 3.8 hours is any more effective,” he said in an interview.

Fraser, along with other nursing home advocacy groups, sent letters and calls to the governor’s office following her comments, but have yet to hear back.

If Raimondo and the health department proceed with the mandates, Rhode Island would have the highest minimum staff-to-patient ratio in the country. The national average is 2.5 hours per patient per day.

Meanwhile, according to an email statement from Adanjesus Marin, coordinator of Raise the Bar on Resident Care and an organizer for the Service Employees International Union (SEIU): “This issue has overwhelming public support with 82 percent of Rhode Island voters in a recent survey declaring their support for a mandatory minimum of 4.1 hours of resident care per day.”

Marin and the SEIU support Raimondo’s proposed mandate. In a press release from Raise the Bar issued on Dec. 17, Marin says there is a “direct correlation” between staffing levels and infection control violations. He cited a recent study from the Harvard School of Public Health in which higher staffing equates to lower COVID-19 infection rates.

According to an analysis from the American Health Care Association, a 3.8 hours mandate would cost an estimated $75 million per year. The mandate would require an additional 800 employees across Rhode Island’s 80 nursing homes.

Fraser is worried that the staff “just isn’t there.”

“We’re in the middle of a pandemic, our homes have been under funded for years, and the state is trying to recruit our employees to work in the field hospitals,” Fraser said.

Prior to the pandemic, Rhode Island ranked “among the top” in nursing home care quality, Fraser said. He believes that Rhode Island homes have “always staffed based on the needs of the residents” and “there’s not a one-size-fits-all that can cover every single one of our residents.” One of Fraser’s biggest concerns is that nursing homes will be forced to close their doors, should the mandate go into effect.

Fraser also fears the rising costs will cause more trouble for nursing homes down the line. “There’s a finite amount of money going into our homes. Every year for the last eight years, the Medicare budget has been cut. If this were to pass, our homes would have to come up with millions of dollars. Where does that money come from? Does the money come from food? Building repairs?”

However, Marin believes the nursing homes’ financial concerns are unfounded. In the statement, Marin said: “The nursing home industry can afford staffing, having earned $241 million in total profit in 2017-2018. Additionally, Rhode Island’s nursing homes received over $60 million in additional state and federal funding since April 1 to support increased staffing, testing, and PPE.”

On Friday, Dec. 18, Raimondo announced that the Department of Health had given the green light to nursing homes to allow essential caregivers to take care of residents. Family members that have a loved one in a nursing home who needs help with activities like bathing, grooming, or eating will be able to sign up to an essential caregiver.

Raimondo said during her weekly press conference that essential caregivers would have to go through a training program and be subject to the same testing, screening, and other COVID requirements as staff members.

“I hope this does something to ease the pain for you and your loved ones,” the governor said. “I am [taking] my cues from the Department of Health and they are quite worried about the issue … It’s a matter of patient safety and it’s a matter of worker fairness.”

Last Thursday, Rhode Island hit a grim milestone with nursing home COVID associated deaths hitting 1,000. Throughout the pandemic, COVID deaths in nursing homes have made up over 70 percent of COVID deaths in the state, compared to the national average of 40 percent.

“The industry continues to claim they are powerless to stop the spread. It is time our elected officials hold industry leaders accountable to keeping nursing home residents and caregivers safe as their lives are put at risk daily,” Marin said.