https://www.nextavenue.org/pennsylvania-nursing-homes-2/
My first story for nextavenue.org, an online publication for “older Americans” like me. #sighs#
In Pennsylvania, Nursing Homes May Soon Have to Provide More Direct Care
Proponents say increasing the amount of time a paid caregiver spends with a resident will improve patient care. Opponents say, given the staffing shortages, the task is nearly impossible.
There’s one thing both sides agree on as Pennsylvania considers a proposed regulation that would increase the current minimum standard of care per nursing home patient from 2.7 hours over a 24-hour period to 4.1 hours:
- The current regulations should be reviewed, as they haven’t been updated since 1999.
- The proposed changes will be tough to implement.
And that’s about it.
Direct-care hours are defined in Pennsylvania as the amount of hands-on care — for example, medicating, feeding, bathing or toileting — provided by one of three types of employees: a registered or licensed nurse or a nursing assistant.
“If a 4.1 staffing regulation, effectively the highest in the country, goes into effect … then we’ll have a real problem.”
Supporters, including Democratic Pennsylvania Governor Tom Wolf’s administration, The National Consumer Voice (a long-term care advocacy group) and SEIU Healthcare (the labor union for health care workers) say the change will be difficult, but will improve patient care and could create thousands of jobs.
“We have got to make sure we’re talking about actual, genuine care hours, not people who are coming into a room, checking a box and going out,” said Democratic State Senator Maria Collett, a former long-term care nurse. “We’ve got to make sure we’re actually putting in that care.”
Those opposed to the change, which includes the Pennsylvania Health Care Association (PHCA), which represents more than 400 long-term care providers and LeadingAge PA, which advocates for nonprofit nursing homes, say the change is beyond challenging: It’s impossible
“Due to work force shortages, providers are already being forced to limit or reject new admissions,” said Zach Shamberg, president and CEO of PHCA, which has branded the proposal “Unfounded, Unattainable, Unfunded.”
He added that, “If a 4.1 staffing regulation, effectively the highest in the country, goes into effect … then we’ll have a real problem.”
Pennsylvania would not be the first state to impose staffing requirements. According to one study, California law requires all nursing homes to provide at least 3.5 nursing hours per resident day.
The Funding Conundrum
Pennsylvania has almost 700 nursing homes known as skilled nursing facilities and which receive federal funding; they’re distinct from assisted living and personal-care homes. More than 100 of those nursing homes already provide at least 4.1 hours, and more than 400 provide at least three hours, according to the state Health Department.
But Georgia Goodman, LeadingAge PA’s director of government affairs, said many of the facilities already meeting the 4.1 threshold have few or no Medicaid patients. Medicaid reimbursements have not been increased in seven years.
“The Medicaid component is a crucial piece of the puzzle,” she said. “You can’t increase wages or add staff if there’s no (Medicaid) reimbursement increase change.”
Pennsylvania officials estimate it will cost $366 million per year to guarantee all skilled nursing home residents receive the minimum of 4.1 hours of care each day. Collett said elected officials know that the jump from 2.7 hours to 4.1 hours will take time, and they are willing to listen to and satisfy industry needs.
“We’re going to get there, so let me help you get there,” Collett said. “I’m not going to entertain a conversation where we talk about not getting there at all. … It’s a matter of working with stakeholders who say they are doing what they can to get there and not have barriers.”
Industry leaders question that $366 million figure and note that Pennsylvania’s Independent Regulatory Review Commission (IRRC) last month concluded that it was unable to determine if the proposed increase in care hours was “in the public interest.”
IRRC also writes that the Pennsylvania Department of Health “should provide more detailed and expanded information related to economic provisions.”
“They need to provide IRRC with thorough data to convey the true impact on this regulation,” PHCA’s Shamberg said.