Now that the pandemic is finally loosening its grip, lawmakers in several states have turned their attention to a popular scapegoat of COVID-19’s virulent spread in long-term care: staffing levels.
In New York, a minimum staffing plan awaiting the governor’s signature would require nursing homes to provide a daily average of 3½ hours of care per patient by a nurse or nursing assistant.
In Arkansas, provider groups praised the first staffing requirement update in a decade as a “big win,” with a nearly 30% increase to 3.6 average direct care hours per resident day that also did away with strict shift scheduling.
Several other states have taken a similar approach to regulating staffing levels.
But even with federal and state standards in place, experts say the rules are easily circumvented.
“The COVID-19 pandemic has exposed how understaffing in our healthcare facilities, especially at our embattled nursing homes, can lead to a dangerous environment for residents and workers,” New York state Sen. Gustavo Rivera (D) told Stateline, a news service of Pew Charitable Trusts.
But Assemblymember Josh Jensen (R), a one-time nursing home employee, countered that setting stricter thresholds could make it harder for nursing homes to fulfill their responsibilities to residents.
“I saw in my experience how challenging the situation was before COVID and the struggles they were facing [with getting enough staff],” Jensen said. “This bill is going to tie the hands of nursing homes and take away the resources they need for the entirety of nursing home care.”
Other states implementing or pursuing higher staffing minimums include New Jersey, Massachusetts, Oregon and Rhode Island. Not all of them plan to increase state Medicaid funding concurrent with those mandates, a major concern at a time when providers are short on workers and the increasing dollars needed to pay them.
“Addressing staffing without addressing the antiquated payment model and the difficulty recruiting the workforce for long-term care is like fixing only one leg of a three-legged stool,” Tara A. Cortes, Ph.D., RN, executive Director of the Hartford Institute for Geriatric Nursing recently wrote for McKnight’s. “Unless competitive and livable wages are provided to the long-term care workforce, recruitment and retention will continue to be a challenge.”