An analysis by Jordan Rau, KFF Health News, of minimum nurse staffing laws in California, Florida, Massachusetts, New York, and Rhode Island and more than a million public records for the most recent quarter available (October to December 2023) finds that “putting a law on the books was no guarantee of better staffing. Instead, many nursing homes operated with fewer workers than required, often with the permission of regulators or with no consequences at all.” Jordan Rau, “States Set Minimum Staffing Levels for Nursing Homes. Residents Suffer When Rules Are Ignored or Waived.” Staffing laws can improve care only if they are enforced.
More than two-thirds of nursing homes in New York and more than half the nursing homes in Massachusetts did not meet their state’s required minimum staffing levels. New York Governor Kathy Hochul “declared an acute labor shortage, which allows homes to petition for reduced or waived fines.” The State Health Department cited more than 400 of the state’s 600+ nursing homes for understaffing, “but declined to say how many of them had appealed for leniency.”
In 2021, state regulators cited a third of California nursing homes (more than 400) with not meeting state staffing requirements that were enacted 20 years ago. The state granted waivers to 236 California nursing facilities “that said work force shortages prevented them from recruiting enough nurse aides to meet the state minimum, exempting them from fines as high as $50,000.”
Legislation signed by Florida Governor Ron DeSantis in 2022 “loosen[ed] the staffing rules for all homes,” allowing facilities “to count almost any employee who engages with residents, instead of just nurses and aides, toward their overall staffing.” Rau reports, “Florida also reduced the daily minimum of nurse aide time for each resident by 30 minutes, to two hours.” Under the new Florida rules, only 5% of nursing facilities staff below the minimum; under the old rules, 80% of facilities would have been considered understaffed.
Rhode Island requires staffing of three hours and 49 minutes per resident. Only 12 of the state’s 74 facilities meet the minimum staffing rule. In Executive Order 23-11 (Dec. 29, 2023), Rhode Island Governor Daniel McKee suspended enforcement of the staffing law, “saying the industry was in poor financial shape and nursing homes couldn’t even fill existing jobs.” He extended the order on February 28, 2024 as Executive Order 24-05. Since 2023, Rhode Island inspectors have cited immediate jeopardy at 23 of the state’s nursing facilities.
Aldersbridge Communities closed Linn Health & Rehabilitation in East Providence and converted the facility into assisted living. Aldersbridge’s CEO Rick Gamache said Medicaid paid the nursing facility $292 per day, “when the daily cost was $411.”
Bannister Center, a Providence nursing home that is staffed 10% below the state minimum, is part of Centers Health Care. Last year, the New York Attorney General sued Centers Health Care’s owners, investors, and relatives (Petition, Press Release), “accusing them of improperly siphoning $83 million in Medicaid funds out of their New York nursing homes by paying salaries for ‘no-show’ jobs, profits above what state law allowed and inflated rents and fees to other companies they owned.”
Mark Miller, the District of Columbia’s long-term care ombudsman, told KFF News, “‘There’s no staffing shortage – there’s a shortage of good paying jobs. I’ve been doing this since 1984 and they’ve been going broke all the time. If it really is that bad of an investment, there wouldn’t be any nursing homes left.’”
The article ends with David Grabowski, health policy professor at Harvard Medical School, saying “federal health officials have a ‘terrible track record of policing nursing homes. ‘If they don’t enforce this [new staffing rule], I don’t imagine it’s going to really move the needle a lot.’”
July 25, 2024 – T. Edelman