Panel urges increased nursing-home staffing

Nurses Activism


In Florida , ratios were voted on and are due to be brought into new compliance by Jan 2002. We all agree in the necessity but wonder how the Nursing Home industry is going to comply. Meanwhile as a Nurse in the LTC industry we struggle...daily. I thought some might be interested over here in the reform battles happening in Long Term Care.


Here is part of bill 1202 from Florida:

Staffing - One of the most significant provisions of the bill is that it establishes new higher minimum staffing levels for nurse aides. These new levels reflect the findings of the federal Health Care Financing Administration (HCFA) study on staffing levels in nursing homes. By January 2002 nursing homes must ensure that residents receive 2.3 hours of nursing aide care daily. This is the minimum level recommended by the federal Health Care Financing Administration in its staffing study published in 2000. The current requirement in Florida is only 1.7 hours per resident per day. In January of 2003 the requirement becomes 2.6 hours per day and in January 2004 the requirement will be 2.9 hours per day. The 2.9 hours per day level is, according to the HCFA study, the optimal level to ensure quality care.

Nursing homes must also post their staffing levels daily and must report to the Agency for Health Care Administration on staff turnover and stability, and staff to resident ratios. When they cannot meet the required staffing levels they must stop admitting new residents. Finally, the bill includes the funding nursing homes needs to meet these new standards.

This is an article just in out of Ohio:

Panel urges increased nursing-home staffing

Friday, August 24, 2001

Jon Craig

Dispatch Statehouse Reporter

Mike Munden / Dispatch

Donald Greenberg, chairman of Families for Improved Care, tells the Ohio Public Health Council that 3.37 hours of direct care each day would be the optimum for nursing-home patients.

After hearing from sign-waving advocates and nervous nursing-home operators, the Ohio Public Health Council yesterday recommended new rules to toughen staffing requirements for long-term care facilities.

The recommendation includes a requirement that nursing homes give an average of 2.75 hours of direct care to patients daily -- up from the current average of 1.6 hours. If the rules are revised, it would be for the first time in 27 years.

Without taking a vote, the council forwarded the revisions to a legislative panel. The changes must be approved by the Joint Committee on Agency Rule Review -- which meets Sept. 10 -- before being ratified by the health council.

Legislative members of JCARR said they have a difficult decision to make.

Rep. Jamie Callender, R-Willowick, chairman of JCARR, said he hasn't polled the committee, but knows the Ohio Department of Health is strongly supportive.

"Anytime you deal with nursing- home rules, you have huge competing interests,'' Callender said.

Sen. Jay Hottinger, R-Newark, called it an issue he has "dreaded coming up.''

Hottinger, JCARR's vice chairman, said improving staff ratios is "politically popular (and) the easy thing to do,'' but expensive for nursing homes.

"There's 100 percent agreement our loved ones need greater care,'' Hottinger said. "I'm not certain how we're able to do that without crippling an industry that is already significantly weakened.''

Hottinger said he loses sleep over the topic because a relative lives in a nursing home. The senator said he often is frustrated when he finds his quadriplegic uncle's dinner has been sitting "ice cold'' for four hours.

Donald Greenberg, chairman of Families for Improved Care, said his group sought an average of 3.37 hours of direct care per resident.

He said he was generally pleased with yesterday's consensus: "We feel half a loaf is better than none. As a first step, we like it better than nothing.''

But Greenberg fears JCARR, composed of eight elected legislators, might not be as receptive. He charged that their votes might be swayed by campaign contributions from the nursing-home industry.

"I'm trying to find solutions to the problem now before I get placed in a facility,'' he said. "Family members are putting their loved ones at risk when they put them in a for-profit facility.''

Kenneth Daily, speaking on behalf of the Ohio Health Care Association, a nursing-home lobbying group, said new rules won't solve the shortage of nurses and aides. A survey by his association found there are about 9,000 staff vacancies in Ohio nursing homes.

"We try to fill these jobs and cannot. We suffer from employee apathy and high turnover rates. So we are not short-staffed by choice or whim,'' Daily said.

There are about 100,000 Ohioans who live in 1,030 nursing homes statewide. State Health Director J. Nick Baird said about 100 nursing homes in Ohio fall below the proposed staffing average of 2.75 hours per resident per day.

Several people testified yesterday that their loved ones get enough care only when family or friends have time to make frequent visits to nursing homes.

Helen Henry of Columbus agreed. Her son died in a nursing home four years ago and her mother is now in one. Henry said she supports the staffing changes.

Clark Law, president of the Advocate of Nonprofit Services for Older Ohioans, said nonprofit facilities already exceed the proposed standards. They average 4.37 hours of staff time per nursing-home patient, he said.

"A facility would have to 'overstaff' to ensure that the minimums are met on any specific day,'' said Law, who asked how the health department will document staff time.

"This would constitute a needless expense and waste of manpower,'' he said.

But Lisa Heermans, president of the Ohio Association of Regional Long Term Care Ombudsmen, said she has yet to hear how more staff hours are "going to adversely affect the care of the resident . . . Imagine that. That we might consider 'overserving' a person in a nursing home.''

Heermans testified that in the first quarter of this year, more than 11,000 Ohio nursing-home residents suffered bed sores -- one of the most preventable conditions among the elderly.

The new rules would require a minimum daily care average of two hours per resident per day by nurses' aides and 12 minutes per day by a registered nurse.

The remaining staff time may be provided by nurses, aides, therapists, dieticians and social-service workers.


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Here is the latest follow up article:

Few support plan for nursing homes


Susan Jaffe

Plain Dealer Reporter

The latest proposal by state health officials to improve nursing home care for more than 100,000 Ohioans has garnered few enthusiastic supporters.

Industry representatives oppose it, and the relatives of nursing home residents and their advocates favor it as just the first step.

Under provisions adopted last week by the Ohio Department of Health's Public Health Council, nursing home residents would receive an average of about an hour more a day of care from either a nursing aide, therapist, social worker, dietitian or activity aide, and require at least a daily average of 12 minutes of care by a registered nurse. On any given work shift, at least one state-tested nurse's aide would be required for every 15 residents.

That would be a total daily average of 2.75 hours of care per resident, compared with the present 1.6 hours. Last year, the state wanted an average of four hours, but Gov. Bob Taft scrapped the idea and asked for an additional review.

On Sept. 10, the issue will go to a joint legislative commission headed by Rep. Jamie Callender, a Willowick Republican. If adopted, the changes would be the first staffing revision in 27 years.

A federal report last year said residents needed an average minimum of 2.9 hours of daily care to help reduce complaints of bedsores, malnutrition, neglect, abuse and other recurring problems linked to inadequate staff levels. Last year, nearly 3,000 residents or their families reported insufficient staffing at nursing homes, according to Debby Allen at the state's long-term care ombudsman's office in Cleveland.

Families of nursing home residents and advocacy groups complain that the proposal gives management too much leeway to duck requirements. They want staff added to every work shift.

"For all mothers, fathers and grandparents, we have to do something to make their life in a facility better," said Donald Greenberg of Families for Improved Care.

Industry representatives argue that it's unreasonable to require more care time when a labor shortage makes it difficult to find additional workers.

"Our members are saying you're coming at us with regulations you know we can't meet," said Peter Van Runkle, president of the Ohio Health Care Association, which represents 650 nursing homes in Ohio.

State officials hoped the new requirements would be an acceptable compromise, said Madeline Dile of the health department's Division of Quality Assurance.

"The department is concerned about the care the residents are receiving, but we have to be realistic in what we're proposing," she said.

Care based on a daily average instead of by work shift allows nursing home owners to schedule more staff during the day and early evening when they are needed most, Dile said.

But Van Runkle said his organization would support the 2.75-hour average if it is calculated over six months instead of 24 hours.

Contact Susan Jaffe at:

[email protected], 216-999-4822

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