Published in the Pawtucket Times on February 25, 2002

A yet-to-be released federal report paints a very bleak picture about the quality of care provided in the nation’s nursing facilities.

According to an article published last week by The New York Times, a draft federal report finds that 90 percent of the nation’s nursing facilities do not have enough nursing staff to properly care for their residents.

Simply, put, the lack of staffing reduces the quality of care provided in nursing facilities, increasing the incidence of bedsores, falls, malnutrition, weight loss, urinary tract infections and blood-borne infections, the report notes.

According to the draft report, which was ordered by Congress, is expected to be officially released by the U.S. Department of Health and Human Services in April, reaching appropriate staffing in nursing facilities would cost the federal government big bucks.

With a $ 7.6 billion annual price tag, about an 8 percent increase over current expenditures – the report – entitled “Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes” – recommends cheaper ways to fix the staffing crunch in the nation’s facilities.

Rather than regulate minimum ratios of nursing staff to residents, the report calls for better management techniques and training of certified nursing aides CNAs) to increase staff productivity and to decrease CNA turnover. Additionally, market demand sparked by an informed public that has access to publicly reported nursing staff data may even increase nurse staffing levels in facilities, the report notes.

The New York Times article does not get to the root of the nation’s staffing problems in nursing facilities, charges Al Santos, executive director of the Rhode Island Health Care Association, the state’s largest trade group that represents nursing facility providers.

“While the article only focused on the inadequacies of staffing levels across the country, it failed to report on its cause – a lack of adequate government reimbursement for nursing facility care,” Santos said.

Santos stated the federal report, which is detailed in the New York Times, is correct in its assessment that the shortage is “likely to become worse.

It should come as no surprise to policymakers that in order to increase wages and to make frontline nursing jobs competitive. Medicaid can no longer pay roughly $ 4 per hour, per patient for shelter, meals, labor costs, special care, certain therapies and other items,” Santos adds. “Costs far outweigh government reimbursements for patient care, and chronic under-funding of Medicaid directly impacts staffing.”

There is no doubt in my mind that the lack of adequate staff in facilities create poor quality of care,” says Roberta Hawkins, executive director of the Alliance for Better Long-Term Care, who also serves as the state’s ombudsman on nursing facility issues. Hawkins said she fears that the continuing staff shortage in Rhode Island facilities will chip away the past 25 years of improved resident care that has resulted from state and federal nursing facility reforms.

Although inadequate pay and benefits are obstacles to retaining staff, Hawkins predicts that it will become even more difficult to recruit CNAs when more horror stories about poor care appear in local newspapers or on state or federal agency websites.

“As a society, all of us are responsible for the care not being provided to nursing facility residents. If we don’t provide that money to pay for the best of care, we are partially responsible for that care not being provided,” Hawkins said.

Hawkins sees as permanent fix to this ongoing staffing shortage found in Rhode Island facilities – tie the reimbursement rate to the level of resident care provided. For instance, facilities with heavy-care residents would receive a higher Medicaid reimbursement rate, which takes into account the increased staffing needs of those residents.

But adequate Medicaid funding is not the only solution to the continuing staff shortage dilemma facilities face, Hawkins warned.

“We need to create upward mobility in nursing jobs, improve training specialty care provided to Alzheimer’s residents, bedridden residents and to those requiring rehabilitation,” she said.

The new federal study doesn’t surprise Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council (LTCCC) and to those involved in providing or regulating nursing facility care in the Ocean State.

Just last year, a statewide LTCCC study found Rhode Island’s nursing facilities reported a shortage of certified nursing assistants, the staff who provide 90 percent of the direct care to residents.

“The report gives us useful information to look at the issue of staffing and quality in Rhode Island nursing facilities,” Fogarty said. “It also should serve as a clear signal to Congress that it must do a better job of planning and funding long-term care.”

A state commission chaired by Human Services Director Jane Haywood, is currently studying how the existing Medicaid reimbursement system can be improved.

Even with a mounting state budget deficit, it is now time for the governor, state lawmakers and state officials to put the energy and resources into tackling this ongoing staff shortage issue.

With major input from the nursing facility industry and from Hawkins and her resident advocates, Haywood’s final blueprint for changes in the state’s Medicaid program must be taken seriously. With a state election looming in November, candidates running for governor, the Rhode Island General Assembly and Congress must do their homework, study the staffing crisis in the state’s nursing facilities, and develop their positions to confront this pressing policy issue.

More than 10,000 nursing facility residents and their families pray that the report to be issued by the Department of Human Services will not end up in some back office on a dusty shelf.