Rhode Island State Capitol in Providence, RI.
Photo credit: gregobagel/Getty Images

The tug of war between nursing home patient advocates and long-term care providers continued last week as a leading Rhode Island advocacy group threw its support behind a pair of bills that would tighten control over operators. 

The bills are championed by Raise the Bar on Resident Care, a consumer advocacy organization that partners with state labor unions. The measures would create a workforce standards board to oversee labor conditions at facilities in the state and require nursing homes to submit yearly, audited financial transparency statements. 

The workforce board would have the power to set minimum wages and working conditions for nursing home workers and also to set standards to ensure employees are aware of their rights. It also could enforce the standards it sets by conducting investigations, enforcing back pay and job reinstatements, and fining repeatedly offending facilities up to $1,000 per violation, plus administrative and legal fees. 

As proposed in the bill’s current form Tuesday, the board would have 13 members, including three spots set aside for care sector representatives. A similarly designed workforce board currently operates in Minnesota, reserving three seats out of nine for sector representatives. 

The transparency bill has the backing of Democratic sponsors in the state Senate and House, but had not yet been formally introduced in either chamber by Friday afternoon. 

Lean times persist

The proposed legislation comes during a time of crisis for Rhode Island providers. Governor Dan McKee (D) declared a “Nursing Home Emergency” in a December executive order that suspended all fines for violations of a 2021 staffing mandate that was among the strictest in the country. 

McKee noted that the state’s long-term care workforce had shrunk by 20% since 2020 and that facilities were faced with a funding shortfall that had grown to $50 million annually, compared to 2012. At least half a dozen Rhode Island nursing homes have closed since 2022, and three more were forced to enter receivership. 

Despite receiving this sympathetic treatment from the governor, state long-term care leaders still expressed concern that the newly proposed oversight could stack even more regulatory burden on providers at a time when they can scarcely afford it. 

“Rhode Island nursing homes have been chronically underfunded for over a decade” said John Gage, president and CEO of the Rhode Island Health Care Association. He noted that the state’s current Medicaid reimbursement methodology is still based on the cost of care in 2011. 

“During the intervening period, there have been annual inflation indexes of 1% per year,” he told   McKnight’s Friday. “Clearly, this has not kept pace with ever-growing expenses. There is also an ongoing historic labor crisis.”

Those reimbursements are currently undergoing a rebase, with new rates and inflation adjustments set to go into effect starting in late 2024 and 2025.

While the proposed workforce board and financial transparency bills are still in early stages of legislation, providers are viewing them with caution and some concern, according to Gage.

“RIHCA is studying the concept of a nursing home workforce board … Based on what we have heard, the transparency bill would create a greater regulatory burden. Facilities already are required to disclose ownership data — owners of the real estate, management company, operator, etc. Requiring multiple levels of audited financial statements seems overly burdensome, but we will wait to evaluate the details.”