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.
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.”