Some States Fighting Medicare Plan to Require Minimum Staffing in Nursing Homes

Yves here. The very fact that Medicare is having to step to try to address inadequate yet permissible poor staffing levels in nursing homes is yet another testament to how the US puts profit over proper care. Note this rule change is subject to public comment though the end of October. You can find a detailed summary at Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (CMS 3442-P) and how to submit a comment here. Note that the number of comments on each side of a proposed rule change matter.

If you have a relative who is or may wind up in a nursing home or see that as a possible outcome for your, please use the link above, clearly state your support for the proposed rule and add a short reason why.

By Tom Conway, the international president of the United Steelworkers Union (USW). Produced by the Independent Media Institute

The World War II veteran had no family by his side as he lay dying, so Ella Wilverding and her union co-workers stepped into the role.

They took turns sitting vigil with the man, talking to him, holding his hand, and making him as comfortable as possible during his final days.

“We have a policy,” explained Wilverding, a certified nursing assistant (CNA) at the Oregon Veterans’ Home in Lebanon, Oregon, and the president of United Steelworkers (USW) Local 9559. “No one dies alone.”

This is the kind of compassionate, top-quality care that ensues when responsible staffing levels empower nurses, CNAs, and other nursing home workers to provide the time and attention that residents need.

Right now, states set their own staffing requirements, and some have none at all. Fortunately, the U.S. Centers for Medicare & Medicaid Services (CMS) recently took the first step in fixing this broken system of care by proposing minimum mandatory staffing requirements for nursing homes across the country.

CMS will take public comments for about two months before issuing a final rule—a window that enables advocates like Wilverding to shine a light on the incredible difference that robust staffing makes and to fight for standards strong enough to revolutionize an essential part of the health care system.

“I wish every facility could be like this,” Wilverding said of the Lebanon location, where she works with seven veterans on an average day shift.

Under Oregon law, each resident there receives at least 2.16 hours of CNA care every day, plus assistance and services from other staff members. Oregon’s staffing standards now rank among the strongest in the nation, but Wilverding champions further improvements, knowing that they would enable workers to provide ever-better care.

The Lebanon site consists of a dozen houses, with as many as 14 residents in each, spread among four neighborhoods on a manicured campus.

CNAs like Wilverding prepare meals, wash the dishes, and handle laundry in addition to helping veterans with bathing, dressing, and other tasks. If residents’ needs increase—such as when the staff mobilizes to provide around-the-clock end-of-life care, for example—the facility schedules additional workers for support.

The home operates training programs for new workers—and partners with a local college on workforce development—to maintain staffing levels. A strong USW contract provides the good wages and voice on the job essential to recruiting and retaining workers.

The focus on responsible staffing enables workers not only to excel in meeting residents’ basic needs but also to develop true rapport with veterans and connect with them on a deeper level.

Workers successfully treated one of the oldest people ever to get and survive COVID-19—then threw the WWII veteran a 104th birthday partyon the lawn. Among many other kindnesses, they arranged a helicopter ride for a resident who served as a flight nurse and a crabbing expedition for a veteran who loved the coast. They make a point of helping residents do their hair and makeup.

“I don’t think you can take good care of people if you have a lot of people to take care of,” said Wilverding, who’s heard horror stories from colleagues in other states.

“You can go in and turn and change somebody,” she said, referring to steps needed to prevent bedsores and keep a patient clean. “But there’s more to caring for people than that. They need us. You’re their family when they’re here.”

Across the country, however, understaffing contributes to uneven care and resident loneliness. Instead of hiring adequate numbers of workers, some facilities bring in robots to socialize with residents or provide other assistance.

But that’s not even a close substitute for human interaction or the expertise that workers like Wilverding provide.

“It’s only going to get worse,” Wilverding said, noting that retiring baby boomers will create surging demand for nursing home care.

Rather than meet their obligations to residents, some operators deliberately understaff facilities, putting profits over people.

Alabama’s nursing home industry, for example, opposes mandatory staffing standards.

But Sarah Hardnett, unit president for USW Local 9201, knows that only federally imposed requirements will force operators in her state to do the right thing and adequately staff their facilities.

“It really breaks my heart. They want us to work short. They don’t care. It’s about saving the company money,” said Hardnett, who described her own battle with understaffing at Magnolia Ridge nursing home in Gardendale, Alabama, as representative of the industry statewide.

“They are doing this because there is no law in Alabama on how many residents we can have,” said Hardnett, referring to facilities with low staff-to-patient ratios. “That doesn’t make it right. They are using it to their advantage.”

Understaffing creates additional risks in a facility. Residents may wait longer for call bells to be answered or injure themselves trying to care for themselves. Workers may strain themselves lifting a resident without adequate assistance.

“If you’re exhausted, there are so many things that can happen,” said Hardnett.

There’s no excuse for putting lives at risk.

CMS has a historic opportunity right now to transform nursing home care. Strong staffing standards would provide more of the compassionate hearts and skilled hands that nursing home residents need above all else.

“We’re not rushed. It’s nice to be able to spend extra time,” Wildering said of the conditions at Oregon Veterans’ Home.

“Residents need to be treated like people, not just bodies that you take care of,” she added. “We can’t do that without adequate staffing.”

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  1. bogwood

    There was a story about recent hunter-gatherer bands, before they became acculturated. If during the annual migrations, you were unable to cross the river, you were left behind. There were many variations on this story but none would lead to nursing homes. Yes, it is easy to decry nursing homes when still mobile. But nursing homes are an artifact of the fossil fuel culture which at least need to dwindle if not disappear. I hope to hold to this view when I get to the river’s edge.

  2. jackiebass63

    My wife had to spend a short time in a nursing home to recover after surgery.She was in 3 different facilities. They all were understaffed. In each facility there was one staff member for each 10 patients. The nurse and aids were constantly caring for patients.Probably one staff member for every 5 patients would be better but not ideal.There was a big turnover of help , which isn’t surprising.I know I wouldn’t do their job for their pay.

  3. Jack

    I tried to leave a comment online using the link given in the introduction. Yes, it takes you to a page describing how to leave a comment. But the link takes you to a page where it is impossible to determine which docket to comment on. I did several searches using different combinations of descriptors and couldn’t find the comment page.

  4. Steve H.

    It’s been two generations since the Nursing Home Reform Law was passed. While that bent the arc toward justice, it sure didn’t solve the problem. Passing a Federal law will have perverse consequences beyond administrative bloat.

    Recall that in early 2020, the Indiana Association for Home and Hospice Care had a meeting in which they were told, that for any company receiving Medicare funding, publicly speaking about ‘staffing shortages’ would result in a $10K per day fine. As the pandemic took off, similar strong-arming led to the closure of facility wings, and ultimately closed a fine local physical rehab facility.

    That was going into the pandemic. It’s worse now. The Federal input was to shut down advocating for more staffing.

    Take a look at the first few paragraphs. Sure looks to me like it’s union activity that is making the difference there. Must be nice to have a Local President on staff.

  5. aj

    A friend of mine used to be a director for several nursing homes (not all at the same time). He is a kind and caring person and got into the business to help people. However, after so many years of having to battle the owners and boards of directors in order to provide adequate care for his residents, he was so burned out he left the industry. He experienced similar issues, not just at for-profits, but also non-profits, and even nursing homes that catered to the well-to-do. Their was always push to decrease staff-to-resident ratios and lower quality of service (known on this blog as “crapification”). It’s always sad to me, when people who truly want to do good in this world get jaded by reality.

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