Put lawmakers' feet to fire

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Toni M. Fatone
Toni M. Fatone
Editor's note: The following letter describes a situation that unfolded for Connecticut nursing homes this year. The arguments may sound familiar to providers in other areas because nursing-hour requirements and funding challenges have arisen in many states.

Everybody wants to fix Connecticut's nursing homes. The problem is, the fix elected officials have in mind is empty rhetoric, and it could do more damage than good.

The state's leaders, looking to get tough after Haven Healthcare made headlines, have proposed sweeping and potentially crippling reforms.

At news conferences, in public appearances and in mailings to constituents, lawmakers are claiming they will ensure there is “not another Haven Healthcare.” They are seeking new oversight, increased staffing and a host of other ideas, yet the proposed budget for the coming year includes a small 1% cost-of-living increase, and inadequate funding to pay for the new staffing and oversight requirements.

At best, this concern for long-term care is misleading. At worst, it is a setup for failure of state nursing homes, and it jeopardizes care for 30,000 frail and elderly residents by making nursing homes more financially vulnerable.

Who pays for more staff

First, consider the facts. The state's current staffing requirement of 1.9 hours of nursing care per day is indeed low, but it does not reflect actual care provided. In practice, every nursing home in the state employs staff at closer to 3.4 hours of care per day. To suggest that nursing homes are leaving residents without the care they need is disingenuous.

If approved, the new staffing levels would require 134 nursing homes to hire about 16 full-time employees per facility, and therein lies the problem. There is not close to enough money to pay for this increased staffing.

The $10 million proposed by lawmakers for staffing increases would be a joke if this were not so serious. Divided among the affected buildings, the increase would provide $71,000 per facility — not even enough to pay the salary of a single full-time nurse. The funds would pay for 0.8765 of a nurse, or about 2.5 minutes of extra care per day for a resident in a 120-bed facility.

The proposal, which calls for the new staff to be hired within nine months, also fails to take into consideration that there is a nationwide shortage of trained nurses and healthcare professionals.

At the same time, the Legislature's Appropriations Committee has recommended a 1% cost-of-living increase for nursing home care in the coming year's budget. Translated into dollars for actual care, the proposed increase equals $53,719 for each of the state's 242 long-term care facilities. That will have to cover the double-digit percentage increases in the cost of medical supplies, electricity and heating oil (because nursing homes, by law, cannot turn down the thermostat).

And, because 50 of Connecticut's nursing homes have union contracts, that increase will also have to pay for a 4% hike in wages July 1.

The cost of the proposed staffing requirements is far closer to $150 million. What's more, legislative leaders know that.

(Officials more recently have admitted that their fiscal note was seriously wrong and it's more like a $115 million price tag. And then they began talking about a 3.6 hours per patient day standard, but that would still be way off the $10 million they have to spend based on the definition of staffing they were using. They also announced that the projected budget surplus of $263 million they were counting on has been decimated to a mere $15.7 million. In a state budget of $18 billion, a margin of $15.7 million is mere “budget dust.”)

Time for tough questions

For almost 10 years, we have discussed increasing staffing levels, and every time, when the cost to the state is estimated, it is deemed prohibitively high. 

Are we to believe that in the current economic climate, the cost of hiring employees has somehow gone down?

We need to ask some tough questions of legislators about their nursing home proposals. What result do they expect from this budget and this staffing proposal? What will they do when nursing homes simply don't have the money to hire the new staff or can't find qualified candidates?

What do they expect nursing homes to do on July 1 when there is no money to give reasonable, decent wage increases to hardworking staff, and to meet the contractually required union wage increases?

What will the state of Connecticut do when nursing homes lose employees to better-paying jobs? What if nursing homes are forced to suspend admissions because they cannot comply with new staffing requirements? And what of the nursing homes that simply have to close their doors?
Connecticut is, in effect, looming on the verge of a massive state budget deficit. This will not help their grandiose staffing plans.

Put simply, the leadership plan is a disaster, and one that risks quality care for public relations. Enough posturing. Nobody wants another Haven Healthcare. Now let's go back to work and make a budget that actually solves the problems. 
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