COVID Deaths in Nursing Homes Lead to State Staffing Rules

At the height of the COVID-19 pandemic, New York State returned many critically ill patients from hospitals to nursing homes, contributing to as many as 15,000 deaths.

There were bodies crammed into refrigerated trucks. Members of the family, forbidden to be with their loved ones in their last moments of life, cried in front of the retirement homes, their hands resting against the glass. Meanwhile, overwhelmed and exhausted nursing home workers struggled to provide care.

In many nursing homes there were simply not enough workers – many of them sick or terrified themselves – to care for so many critically ill and dying residents. Now that the pandemic is finally loosening its grip, New York and several other states are setting higher standards for nursing home staff.

A bill passed by the New York Senate and Assembly, which Democratic Governor Andrew Cuomo is likely to sign, would require nursing homes to provide a daily average of 3.5 hours of care per patient per a nurse or caregiver. A separate budget bill, also passed by both chambers, would require nursing homes to spend 70% of their income on patient care. Of this 70%, at least 40% should be devoted to the remuneration of nurses.

While there are federal and state standards for staffing, experts say the rules are easily bypassed.

“The COVID-19 pandemic has shown how the understaffing in our healthcare facilities, especially in our struggling nursing homes, can lead to a dangerous environment for residents and workers,” said the Senator Gustavo Rivera, Democratic Chairman of the Health Committee and main sponsor. of the bill, said in an email to Stateline.

History of Stateline

Staffing nursing homes was difficult before the pandemic. Now it’s even harder.

But Assembly Member Josh Jensen, a Republican, said setting staffing thresholds could make it harder for nursing homes to meet all of their responsibilities to residents. Jensen spent a year as director of communications at a nursing home in his upstate district before he was elected to the assembly last November.

“I saw in my experience how difficult the situation was before COVID and the struggles they faced [with getting enough staff]”Said Jensen.” This bill will tie the hands of nursing homes and take away the resources they need for all nursing home care. “

Jensen also said the $ 64 million lawmakers put into the state budget each year to help nursing homes hire more staff was not enough. New York, he said, “is just putting in more mandates with insufficient financial support.”

Exaggerated numbers

A 2018 study of federal data by Kaiser Health News found that most nursing homes were exaggerating staffing levels. Using data from Medicare’s Daily Payroll Records compilation, Kaiser found that staff fluctuated from day to day, and many homes were understaffed on weekends.

Prior to 2010, the Kaiser study found that Medicare assessed a nursing home’s staffing levels based on the facility’s unaudited reports, which likely led to inflated numbers.

There is evidence that this type of exaggeration persists. In March, the state of California sued a national company, Brookdale Senior Living, accusing it of filing false workforce numbers. Brookdale owns and operates more than 700 senior and retired communities in the United States.

In filing the lawsuit, California Attorney General Xavier Becerra released a statement accusing Brookdale of “artificially increasing profits by cutting corners when transferring or discharging his patients.” It has drawn people to its facilities with false promises to provide the highest quality care. A few days later, the United States Senate confirmed that Becerra was the secretary of the United States Department of Health and Human Services.

The Long Term Care Community Coalition, an advocacy group for nursing home residents, reported that in Q4 2020, nursing homes in New York City were providing an average of 3.45 hours of care per day per patient. , ranking 32nd state in the country. A 2001 federal study took 4.1 hours.

Low standards?

While Jensen argued the standards were too hard to meet, the New York State section of AARP, which advocates for seniors, said the bill’s requirements did not go far enough. .

Bill Ferris, AARP representative in New York, said in a telephone interview that while the New York bill “definitely goes in the right direction,” the standards are too low.

“During negotiations, the bill went from 4.1 to 3.5 hours per day. We were disturbed by this, ”he said. “The other problem is that they have at least 1.1 hours to [licensed practical nurses and registered nurses]. We did not like this because AARP believes that the more care a nurse provides, the better the results. We believe this is not enough.

The federal Centers for Medicare and Medicaid Services (CMS) call for “adequate” staff to meet the needs of nursing home residents. But AARP’s Rebekah Mason, a senior legislative representative, said the agency never adequately defined, although a CMS document uses the 3.5-hour standard. Some states, such as California, use this standard, but allow exceptions depending on the circumstances.

“The devil is really in the details,” she said. “States determine how they train and how they license workers in nursing homes. When we look at these bills, we look at apples and oranges. Different workers are trained with different standards. Aggregation of what is flagged as direct care may not benefit residents if they are not careful. “

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Mason designated New Jersey as a state where a new law established a reasonable standard of care.

Driven by the pandemic, New Jersey Gov. Phil Murphy, a Democrat, signed a bill late last year establishing minimum ratios of direct care staff per capita in nursing homes. The new law provides for one certified nursing assistant for every eight residents on the day shift, one nurse or CNA for every 10 residents on the evening shift, and one staff member for every 14 residents on the night shift.

The law, Murphy said in his signing declaration, requires long-term care facilities to institute policies that prevent the social isolation of residents.

“Unfortunately, too many retirement homes are run by companies more concerned with making money than protecting patients,” he said. “These much-needed reforms will help hold the industry accountable and protect residents, staff and family members with loved ones living in long-term care.”

Massachusetts also announced new regulations last fall that require a minimum of 3.5 staff hours per patient and require investment of at least 75% of revenues into direct nursing staff costs.

Stories of the pandemic have spurred this action, especially in New York City with its high nursing home death toll.

At a Health Committee hearing last August, a New York resident named Bonnie Webster said her mother died in a nursing home in Avon from COVID-19 and her father had died. committed suicide shortly after, out of desperation. Part of the problem, Webster said, was the unresponsiveness of the overwhelmed and decimated staff.

“Our nurses and staff did not have the tools or the staff to properly care for our family members,” said Webster. “It’s just horrible what happened. Unfortunately, our family has suffered a severe blow from this pandemic. “

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