Tag Archives for Alliance for Better Long-Term Care

Staffing Crisis Hits Nation’s Nursing Facilities

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.

Adequate Medicaid Payments Can Bring High Quality Health Care

Published in the Pawtucket Times on January 21, 2002

Like clockwork each year, Robert Hawkins, the state’s best-known consumer advocate for quality nursing home care and the state’s nursing facility industry, came to Smith Hill, calling on the General Assembly to adequately fund long-term care.

While representing different constituencies, both Hawkins and the nursing home industry were on the same page regarding this policy issue. Both groups strongly urged the Rhode Island General Assembly to adequately fund the state’s Medicaid program. For its Medicaid dollars, the Rhode Island Department of Human Services got: 24-hour nursing care; three meals per day with dietary supplements; other care services like grooming, personal care, bathing and assistance with eating; medical supplies, such as beds and wheelchairs; social services and activities.

Some years were better than others, especially last year. Responding to a serious statewide nursing assistant shortage, Rhode Island lawmakers gave an additional $9 million to pay for nursing facility direct care staff. However, the Rhode Island Health Care Association said that those funds did not cover the spiraling costs of operating a facility.

Liability insurance has doubled, energy costs have risen by approximately 25 percent and Providence-based facilities have been hit with tax increases with some facilities being assessed close to $ 100,000, noted the state’s largest nursing facility trade group.

Now, a recently released national study supports nursing facility and consumer concerns that the Rhode Island Medicaid program has not paid the “real” cost of providing care to Medicaid patients.

According to an independent analysis of the nation’s Medicaid pr.0ogram by the accounting firm of BDO Seidman, the Ocean State’s Medicaid program underfunds its nursing facility industry by more than $25 million annually or about $10.04 per patient day.

According to the national study, most states fail to adequately account for escalating Medicaid costs. They do this by using cost inflators that are not reflective of actual nursing facility cost increases and by using extremely outdated data.

For instance, Rhode Island uses data using 1991 costs in setting rates for most nursing facilities.

“The most disturbing finding of this study is that the state is reimbursing senior’s long-term care for substantially less than the acknowledge cost of that care,” says Alfred Santos, executive vice president of the Rhode Island Health Care Association (RIHCA). “Medicaid pays just slightly more than $4 per hour per patient, less than most people pay a teenage babysitter,” Santos charges.

Adds Hugh Hall, administrator of the Cherry Hill Manor, the cost of care in his facility is higher than most because of the acuity of his residents. Being under paid by Medicaid by $40 dollars per day significantly impacts the operation of his Johnston-based 172-bed skilled nursing facility, Hall says, noting that it forces the facility to look for other sources of payment to compensate for the state’s shortfall.

Hall called for a national commitment to adequately pay for care provided to the elderly and the younger subacute care population coming in nursing facilities.

“In Rhode Island, we’re working to educate the General Assembly so they understand the shortfall of the current Medicaid system, says Hall, specifically noting that the negative impact of not keeping up with annual cost changes affecting nursing facilities and not recognizing more immediately the capital costs required to maintaining a physical plant.

Hawkins, executive director of the Alliance for Better Long-Term Care and the state’s ombudsman brings the Medicaid payment issue down to a personal level: “How would any person like to have their salary level based on 1991 costs?”

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

“While we are demanding the highest quality of care to be delivered in Rhode Island facilities, we are not ensuring that the facility is being paid adequately to reach the quality that we are demanding from them,” adds Hawkins.

“While there may be areas where a facility can save money, it should certainly not come from a facility’s budget to ensure appropriate staffing levels or to pay for qualified nursing staff,” notes Hawkins.

“Nursing facilities are between a rock and a hard shell because they cannot recruit staff because of low wages that result from the current Medicaid reimbursement system, and they cannot hire additional staff either,” says Hawkins.

Lt. Governor Charles J. Fogarty, who heads the state’s Long-Term Care Coordinating Council, states that the General Assembly is now working to address the concerns of consumers and providers over the state’s inadequate Medicaid reimbursement policy.

Fogarty stated that he serves on a work group, administered by the state’s Department of Human Services with members from the House and Senate, to review the state’s current reimbursement Principles for Nursing Homes and other components of the long-term care system. The state-level work group has been meeting for several months and came into existence as a result of lawmakers confronting the severe certified nursing assistance shortage in nursing facilities, the Lt. Governor said.

Fogarty states the work group is in the process of considering the hiring of a consultant to ultimately shape the state reimbursement policy on Medicaid.

“This issue will not go away,” he said, noting the state’s growing aging population. “Nursing facility residents are now sicker and require more intensive care than they did 14 or 20 years ago, noted Fogarty.

Jane Haywood, director of the state’s Department of Human Services, says that her agency recognizes there is a myriad of issues relating to nursing facilities and the long-term care continuum the state must address. The legislatively mandated workgroup is expected to develop proposals of reforming the state’s Medicaid system and entire long-term care system by spring, Hayward adds.

When something is broke fix it.

No Rhode Island company can not survive for long with their revenues not covering their operating costs.

Now it is time for the state to follow this longtime sound business principle when it revamps its ailing Medicaid program. With adequate state funding, Rhode Island regulators can rightfully better demand quality from nursing facilities. With more money in their coffers, facilities had better produce that quality of care, too.

The message should be clear to the nursing home industry – it’s now time to get the gang for the buck.



Congressional report spotlights nursing home abuse

Published in The Times dated August 6, 2001

Congressional investigators have recently released a scathing report charging that within the last two years more than 30 percent of the nation’s nursing homes – about 5,285 facilities – were cited by state inspectors for at least one abuse violation that had the potential to cause harm.

These facilities were cited for almost 9,000 violations during the two-year congressional study, the report said.

Citing information gleaned from a sampling of state inspection reports or formal complaints, the 15-page report released last week at a hearing called by Henry Waxman (D-Calif), Minority Chairman of the House Committee of Government Reform, found that in more than 1,600 nursing facilities, approximately one out of every 10, the abuse violations were serious enough to cause significant harm to residents or to place them in immediate jeopardy of death or serious injury.

Abused residents were punched, choked or kicked by staff members or other residents, the report said, stating that the attacks frequently caused serious injuries such as fractured bones and lacerations.  In other instances, residents were being groped or sexually molested.

Although the report, “Abuse of Residents is a Major Problem in U.S. Nursing Homes,” prepared by Minority Staff of the Committee’s Special Investigation Division, found that the percentage of nursing facilities with abuse violations is increasing, it noted that the reasons for this increase are unclear.

In his opening remarks, Waxman stated that it had been unwise for Congress to repeal the Boren Amendment in 1997, a federal law which mandated that states provide nursing facilities with adequate funding to operate.  Because of this, he said, Medicaid funding for nursing facility care has not kept pace with the rising costs of providing care.

Waxman’s legislative prescription for attacking the growing abuse in the nation’s nursing facilities is to introduce a legislative proposal that would reestablish the abolished Boren Amendment, mandating minimum nurse staffing requirements, imposing tougher regulatory sanctions on poorly performing facilities, and instituting criminal background checks for nursing facility employees, or increasing internet disclosures on nursing facility care.

What’s playing out in Rhode Island?

According to Wayne Farrington, Chief of Facilities Regulation at the state’s Department of Health, the reporting of Rhode Island abuse complaints has risen by 10 percent.  The statewide increase in reports of abuse, neglect and mistreatment probably mirrors the tragic national problem, he tells All About Seniors, but is smaller because the Rhode Island 1987 statute has made it a misdemeanor for health care professionals or public safety officials not to report suspected abuse, neglect, mistreatment.  The size of the national increase is partially due to abuse reporting being a new requirement in some states.  Farrington added. 

Farrington states that the biggest factor that increases the number of reported calls of abuse, neglect and mistreatment is the severe statewide staffing shortage in Rhode Island’s nursing facilities.

“Overworked staff may become short tempered and this can result in abuse.  Not enough staff in the facility may also result in resident’s needs not being met,” he added.

Administrator Hugh Hall, of Cherry Hill Manor, also feels that the state’s critical staffing crisis contributes to the possibility of increased abuse and that crisis also affects the quality of care provided in the state’s 104 nursing facilities.

“Today’s nursing facility employees are underpaid, overworked creating an environment in which even the best employee may falter,” Hall said.

The administrator urges the General Assembly to increase Medicaid payments to more adequately cover the nursing facility’s actual cost of care, allowing for greater increases in direct care provider salaries.

“While last year’s average cost of care in a Rhode Island facility was $140 per day the state’s Medicaid program only reimbursed facilities $116 for the care provided, creating a serious shortage of funds in many facilities, Hall added.

“There are not enough certified nursing assistants in the system to deliver the care,” Hall said noting that opportunities must be created and a fair wage paid to attract people into this profession.

Meanwhile, Hall believes that the overwhelming majority of nursing facilities in Rhode Island provide quality care.  These facilities do criminal background checks and provide staff training.  They educate their staff about the facility’s expectation on quality patient care, he said.

Hall says facilities that have on going problems with abuse should be prosecuted to “the fullest extent of the law.”

Although Roberta Hawkins, the state’s Long-Term Care Ombudsman and Executive Director of the Alliance for Better Long-Term Care sides with Farrington and Hall about the critical need to directly confront the adverse impact of the staffing shortage in facilities, “it’s not to excuse to provide bad care,” she says.  “If facilities can’t care for residents then they should not admit them.”

A mandated continuing education program for both professional nurses and certified nursing assistants can be an effective strategy for reducing the incidence of abuse while enabling the better trained worker to care for more medically complex residents.

Additionally, Hawkins and long-term care providers are pushing for more state and federal Medicaid dollars to be allocated to provide a living wage for direct care workers.

Although lawmakers this year gave a small increase, “it’s not what was needed but it’s a start,” she acknowledges.

A divided Congress and a conservative Bush White House may well keep Waxman’s legislative proposal that addresses the problem of rising abuse in the nation’s more than 17,000 nursing facilities from every being enabled.

So, change must begin in the Ocean State.

When the Rhode Island General Assembly comes back into session next year, it becomes critical that the serious direct care staffing shortage in Rhode Island’s nursing facilities become a top legislative priority.

As the Republican and Democratic Gubernatorial candidates gear up their political campaigns and dream of becoming the state’s top elected policy official, they might well consider taking up the just cause of improving the care provided in the state’s nursing facilities.

Lawmakers can gubernatorial candidates can ill afford to ignore this key policy issue, one that puts the state’s 10,000 frail nursing facility residents in continued jeopardy of abuse, neglect or mistreatment.

On a political note, hundred of thousands of families and friends of these residents, who are voters, are watching.