Zach Shamberg

New staffing ratios for Pennsylvania’s nursing homes that went into effect Saturday will combat unsafe working conditions and improve residents’ quality of care, union representatives claim. 

“There’s not really a workforce shortage,” said President of SEIU Healthcare PA Matthew Yarnell. “There’s a shortage of people who are going to continue to work in conditions where they are unsafe or the residents are safe.”

Matt Yarnell, president
of SEIU Healthcare PA

Yarnell’s comments came during an SEIU press conference Friday during which he, caregivers and others discussed the staffing ratios that provider groups have said will exacerbate a shortage of nursing home workers. The American Health Care Association and National Center for Assisted Living have said that the sector lost 210,000 jobs during the pandemic, bringing nursing homes to their lowest employment levels since 1994.

Sector advocates in the state had agreed to support the staffing increases as part of negotiations to secure an historic Medicaid increase for providers.

The Pennsylvania Bulletin — the state’s equivalent of the Federal Register — projects that facilities will need to hire 522 full-time equivalent LPNs in fiscal year 2023-2024 and 249 full-time equivalent CNAs. In fiscal year 2024-2025, facilities will need to hire an additional 1,389 CNAs. 

The new rules will cost an additional $58 million in the first year and $142 million in the second year to hire the number of certified nurse aides and licensed practical nurses facilities need to be in compliance, according to state estimates. 

Pennsylvania’s new ratios will be phased in over two years. As of Saturday, there must be one certified nursing aide for every 12 residents on day and evening shifts, and one CNA per 20 residents for night shifts. The ratio also requires one licensed practical nurse for every 25 residents on day shifts, one LPN for every 30 residents on evening shifts, and one LPN for every 40 residents on night shifts. 

On July 1, 2024, the ratios will increase to one CNA for every 10 residents on day shift, one CNA for every 11 residents on night shifts, and one CNA for every 15 residents on night shifts. 

The regulations, signed into law in 2022, also set a minimum requirement of 2.87 hours of direct patient care per day, starting Saturday. On July 1, 2024, that will increase to 3.2 hours of nursing care for each resident per day. The minimum number of hours before Saturday was 2.7.

Jeanne Parisi, deputy secretary for Quality Assurance for the Pennsylvania Department of Health, said surveyors have been trained to check staffing ratios and rosters and verify that nurse aides listed for each shift were working. Surveys take place at least once every 15 months, but the department can increase that if there are complaints or incidents, she said, adding that facilities will need to submit correction plans if they are found in violation of the staffing ratios. 

The Pennsylvania Health Care Association told McKnight’s Long-Term Care News that funding to ensure that facilities can hire enough staff to meet the new rules is “critical.” The state legislature is in the midst of budget season, and it remains to be seen what resources will be made available for the sector. 

“Every industry is struggling to hire more workers, so we’ll need the full support of our government leaders and every long-term care stakeholder to ensure those workers exist so that care demands can be met,” association President and CEO Zach Shamberg (main photo) said in a statement. “An unfunded mandate will only harm long-term care in Pennsylvania, and we encourage Gov. Josh Shapiro and legislative leaders to uphold a commitment and fund the forthcoming staffing mandate in this year’s budget.”