Tag Archives for COVID pandemic

When the dust settles. Looking back at 2024’s legislative days

Published in RINewsToday on June 24, 2024

Over a week ago, after being in session for 49 legislative days (opening day was Jan. 2, 2024), the Rhode Island General Assembly held its final session at 4pm on June 13, 2024, and ended at about 1:30am on June 14, 2024. During this year’s legislative session 1,167 bills and resolutions were introduced in the Senate, and 1,369 in the House. This total does not include Resolutions, which were  congratulatory in nature or noted prominent Rhode Island residents who have passed away.

With the dust settling at the end of this year’s session, there were 249 bills that passed both the House and Senate, and that are now sitting on Gov. Dan McKee’s desk for his signature to enact, or to pass without signature, or to be rejected.

“This was an outstanding legislative year for Rhode Island’s seniors,” observes House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick). “In addition to all the investments for seniors made in the state budget that has been signed by Governor McKee, there were excellent bills that will be of great benefit to our aging population, he says. 

Attacking the housing crisis head on

In a joint statement, the House Speaker and Senate President Dominick Ruggerio said, “It is critical to attack our housing crisis from many different angles. Allowing ADUs in other states has been proven to make a significant impact by immediately increasing available housing supply.  We are confident that ADUs will be beneficial for the many Rhode Islanders who need flexibility in housing options, particularly seniors wishing to age in place in their communities,” they say.

Shekarchi points out the enactment of ADU legislation sponsored by House Commission on Housing Affordability Chairwoman June S. Speakman (D-Dist. 68, Warren Bristol) and Sen. Victoria Gu (D-Dist. 38, Westerly, Charlestown, South Kingston) that would boost the development of accessory dwelling units (ADUs), which are also known as in-law apartments. The House Speaker is the House bill’s top co-sponsor.

“I have heard from so many seniors who would like to downsize and continue to live independently, but would enjoy the extra assurance of living on the property of their children,” he noted, thanking AARP Rhode Island and housing advocates, including Rhode Island Housing, Grow Smart RI and Housing Network RI, who pushed this “significant legislation” across the finish line. 

The bills (2024-H 7062A, 2024-S 2998A) would provide homeowners statewide the right to develop a single ADU on an owner-occupied property or within the existing footprint of their structures or on any lot larger than 20,000 square feet, provided that the ADU’s design satisfies building code, size limits and infrastructure requirements.

The purpose of the bill is to encourage the development of rental units that are likely to be more affordable than many other apartments, and also to provide opportunities for homeowners with extra space to generate income that helps them maintain ownership of that property.

To ensure that the bill achieves its goal of housing Rhode Islanders, the legislation prohibits ADUs constructed under this provision from being used as short-term rentals, and streamlines the permitting process.

In the HEALTH arena

According to Senate President Dominick J. Ruggerio, several legislative proposals in the Senate’s health care package passed the General Assembly.

“Few issues are as important as health care, and right now, our health care system is in critical condition. Health care absolutely must be accessible and affordable for all Rhode Islanders,” says Ruggerio, noting that for too many people in the Ocean State is too expensive or too difficult to get. “And we know that many health care providers are feeling enormous strain due to many factors,” he adds.

“Like providers and consumers, our community hospitals, including Fatima in my district, are facing difficult circumstances,” said the Senate President, who recognized his Senate colleagues in the development of this package of legislation.

“As we celebrate our victories in the 2024 session, we are committed to continuing our work on this issue and accomplishing all the objectives of the HEALTH initiative. “

According to Ruggerio, several legislative proposals in the Senate leadership’s HEALTH (Holistic Enhancement and Access Legislation for Total Health) initiative include legislative proposals to join five interstate licensing compacts to make it easier for Rhode Islanders to access the care they need and budget provisions to use $1 million of general revenue to purchase debts of struggling Rhode Islanders and incentivize providers to enter primary care fields.

Advocates on aging give their recap of the 2024 Legislative Session

“The Senior Agenda Coalition of RI supported several housing-related bills (that did not pass) that would benefit older adults including those sponsored by Rep. Meghan Cotter (D-Dist. 39, Exeter, Richmond, and Hopkinton)  and Sen. Linda Ujifusa (D-Dist. 11, Portsmouth, Bristol) to increase the income cap for the Property Tax Relief program to $50,000 and the credit or refund to $850 to help offset the cost, of property taxes and rents for older adults and persons with disabilities,” says Maureen Maigret, Policy Advisor for the Senior Agenda Coalition of RI (SACRI), noting the Coalition plan to continue to advocate for them next year.

Maigret warned that with a growing older population the need for more accessible housing will increase and the Coalition supported and will continue to support bills to create greater accessibility in new housing.  

Maigret stated that SACRI will also continue to support legislation to create a caregiver tax credit as provided for in 2024 legislation sponsored this year by Rep. Susan Donovan and Sen. Linda Ujifusa. “Our caregivers are valued and deserve our support. A caregiver tax credit will help the many R.I. family caregivers who provide thousands of hours of care for spouses and parents often spending thousands of dollars of their own money to give their loved ones a better, more comfortable life,” she says.

She noted that SACRI also plans to build on its efforts to further expand the Medicare Savings Program to help more lower-income persons on Medicare afford needed healthcare by covering required co-pays and deductibles and to continue its work to promote quality long term care through support for staffing standards, worker training programs and Medicaid enhanced reimbursement for private rooms to help with infection control issues that became so apparent during the Covid pandemic.

SACRI will also push next legislative session to enact legislation to establish a formula for state funding to support local senior centers and programs based on a community’s population of those 65 years and over.  

Raise the Bar on Resident Care and other advocates successfully pushed the passage of H 7733 and S 2621 legislation sponsored by Rep. Scott Slater (D-Dist. 10, Providence) and Sen. Bridget Valverde (D-Dist. 35, (East Greenwich, North Kingstown, South Kingstown) that would establish the Nursing Home Work Standards Board (NWSB). According to Raise the Bar, NWSB will help stabilize the nursing home system by establishing training standards, promoting caregiver rights, depoliticizing funding allocations and implementing financial oversight of nursing homes.  A 13-member board (including frontline staff, nursing home management representatives, state government and community organizations will work with Medicaid to ensure comprehensive and informed decision-making.

“In 2023, Minnesota passed its own Nursing Home Workforce Standards Board and just voted to raise wages for caregivers to over $23 an hour in 2027 while guaranteeing 11 paid holidays. Here in Rhode Island, the Workforce Standards Board is a critical step toward transforming nursing home jobs into sustainable careers that can support a family and provide quality resident care. Now we need Governor McKee to show his support and sign this bill into law,” said Jesse Martin, Executive Vice President of SEIU 1199 New England, member of Raise the Bar on Resident Care.

Raise the Bar also advocated for the passage of the Financial Transparency Act (S 2604 | H 8204) but ultimately pulled the bill in order to re-adjust some of its language. This legislative proposal, S 2604, sponsored by Sen. Dawn Euer (D-Dist.13, Newport, Jamestown) and its companion measure, H 8204, sponsored by Rep. Matthew Dawson (D-Dist.65, East Providence) would require nursing homes to provide annual, audited financial statements that include detailed income, expenses, and cash flow, alongside transparent ownership information to prevent for-profit owners from misusing Medicaid and Medicare dollars. “We look forward to advocating for its passage in next year’s legislative session to ensure all for-profit nursing homeowners are held accountable to investing public dollars appropriately in direct care,” continued Jesse Martin. 

Advocates for Better Care in Rhode Island, a grassroots community organization founded to advocate for the rights and interests of residents of long-term care facilities in RI, celebrates the passage of S. 2263. The Long-Term Care Residents Rights Camera Bill, notes Director Kathleen Gerard. 

“The legislation gives residents of nursing homes and assisted living facilities and their legal representatives the right to install a monitoring device in their room provided all residents in the room consent. The consent can be withdrawn at any time, and a variety of safeguards exist to protect resident privacy,” says Gerard.

The legislation, S 2263 A, sponsored by Sen. Dawn Euer (D-Dist. 13, Newport, Jamestown, who chairs the Senate Committee on Judiciary and H 7969 A, sponsored by Deputy Majority Leader Jason Knight (D-Dist. 67, Barrington and Warren) has been signed by the governor and will take effect Jan. 1, 2025.  

According to Gerard, the legislation was first introduced in this form in 2021, but the care staffing crisis and massive 138% increase in serious deficiencies cited in RI long-term care facilities since 2022 made it even more urgent to finally pass it this year.

“Speaker Shekarchi worked tirelessly to reach a compromise that was acceptable to the various parties supporting and opposing the bill, and long-term care residents will consequently soon be able to have their care and condition monitored remotely by loved ones and care-partners, resulting in more peace of mind for everyone,” she says. 

“A legislative proposal we backed this year and that we hope to see enacted next year was introduced by the Rhode Island Department of Health.  The legislation, (S 2818 sponsored by Sen. Joshua Miller (D-Dist. 28, Cranston, Providence and H. 7819 sponsored by Rep. June S. Speakman), would improve financial transparency in nursing home ownership and prevent the rapid extraction of equity from facilities that we see with many private equity firms, real estate investment trusts, and investor groups,” says Gerard.

Next legislative session, Gerard says Advocates for Better Care in Rhode Island will also continue to advocate for legislation requiring assisted living facilities to support family councils.   This requirement already applies to nursing homes, she notes.

“We’ve Only Just Begun, says Sandra Paquette, representing Advocates for COLA Restoration and Pension Reform, a non-profit representing 4,700 retirees. “Our group numbers continue to increase, along with our determination and commitment, to fight for the justice which was so unnecessarily and ruthlessly taken away,” she says. .

According to Paquette, there were legislative proposals pertaining to current and future state and teaching retirees, which did not reach the floor of the House or Senate. One legislative proposal applied to those active employees whose retirement is based upon an arbitrary “rule of 95”. This translates into a calculation where the years of service and the age of those wishing to retire must add up to 95. The law would have changed this total to 90. Another one for which we strongly advocated, and for which we provided thousands of letters, verbal testimony and volunteer lobbying sessions was Pat Serpa’s (D-Dist. 27, West Warwick, Coventry and Warwick), H-8193, would have restored a compounded Cost of Living Adjustment (COLA) to all current and future retirees, and would have been enacted as of July of this year.

“Our goals for next year will remain— to advocate through testimony, letters, media and lobbying–for the passage of the two bills which will provide the now essential support to the victims of the 2011 Rhode Island Retirement Security Act,” says Paquette.

And here are specifics about other bills that impact seniors:

Advocates, providers on new Nursing Home mandates

Published in RINewsToday on April 29, 2024

In the shadow of Rhode Island’s ongoing staffing shortage, the Center for Medicare and Medicaid Services (CMS) issued its 329-page final rule on Nursing Home Minimum Staffing Standards (CMS 3442-F) on April 22 in the Federal Rule. 

CMS affirmed its commitment to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare-and Medicaid-certified long-term care facilities.  

According to CMS, over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.

Just the Nuts and Bolts

CMS say that central to its final rule are new comprehensive minimum nurse staffing requirements that would significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.  The agency is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities are given the flexibility to use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.

CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

This final rule provides a staggered implementation timeframe for facilities to meet the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors. The requirements of this final rule prioritize safety and health care quality while taking into consideration the unique workforce challenges some nursing homes are facing, especially those operating in rural areas. 

CMS will closely monitor and evaluate the provisions of this final rule, including but not limited to, the minimum staffing standards, the 24/7 RN requirement, the exemption process, and the definition of rural, as they are implemented over the next several years to determine whether any updates or changes are necessary in the future. 

Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

Provider, advocate positions on new CMS final rule

At press time, the RI Department of Health (RIDOH) had no comments about CMS’s new final rule released last week, say Joseph Wendelken, RIDOH’s public information officer.  The state agency is reviewing the rule and assessing its impact and applicability in Rhode Island,” he says.

With the final rules release, senior advocates and providers are expressing their opinion about its impact.

Former President Donald Trump, who is challenging President Joe Biden for the presidency, has not addressed quality of care in nursing homes with a formal position.  Kathleen Heren, Rhode Island’s Ombudsman, speculates that by releasing the CMS mandate before the upcoming presidential election, President Biden is just trying “to establish a record” of enhancing quality of care in nursing homes.

“Nursing homes cannot find  Registered nurses (RN), and Nursing Assistances to hire,” notes Heren.  The CMS mandate will force nursing homes to downsize, like we have just seen happen at the Scandinavian Home,” she predicts.

According to Heren, the final CMS rules do not include the minimum staffing of LPNs. More important, “it’s an unfunded mandate,” she says.

Gerontologist Deb Burton, MS, executive director of RI Elder Info, is pleased to see a Federal minimum staffing mandate of 3.48 hours of daily nursing care. “It’s important to understand mandates don’t make workers appear and a minimum staffing mandate is only an average amount of time allotted for care across all residents in the facility,” she says, noting that this rule doesn’t mean each resident will receive 3.48 hours of care each day.

According to Burton, the CMS Nursing Home Compare website, as of April 2024, notes there are 6 Rhode Island facilities that would not meet the lower federal minimum staffing mandate if it were enacted today. “The workforce shortage and the dire need to increase Medicaid reimbursements to attract and retain adequate staff with a proper wage are common topics of meetings,” says Burton. 

“When workers say ‘It’s only me on the floor – do I help the resident eat their supper or take the other resident to the bathroom? I can’t do both,’ – we need to listen,” says Burton. “The new federal minimum staffing mandate is a good step forward, but we need more. One day it will likely be us waiting for that workers’ help,” she warns. 

Like other RI senior advocates, Maureen Maigret, policy director for the Senior Agenda Coalition of RI, sees the importance of CMS releasing its final rules.  “It is important that these regulations have been finalized as providing for minimum nurse staffing levels in nursing homes helps  ensure residents across the country will receive quality and resident-centered care,”  she says. 

According to Maigret, Rhode Island has had a provision for 24/7 RN coverage even before the state’s minimum staffing law was passed so that is not a new requirement here. She pointed out the regulations will also promote transparency and accountability by requiring public reporting on how much of the Medicaid payments are spent on direct care staff and that the federal government has committed to invest over $75 Million in an initiative to increase the number of nurses working in nursing homes through such things as financial incentives for tuition reimbursement.   

“We are dismayed that the Biden Administration is moving forward with this one-size-fits-all staffing mandate,” says John E. Gage, President and CEO of the Rhode Island Health Care Association. “In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors in Rhode Island and across the country,” he warns, noting that when nursing homes can’t find nurses and/or certified nursing assistants (CNAs), they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need.

New final rule just another unfunded mandate

Like the 2021 RI staffing law, the Federal rule is an unfunded mandate, charges Gage. “Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers, he states.

According to Gage, nationally, the nursing home workforce has declined by 124,200 individuals (-7.8%) since the start of the pandemic. Rhode Island’s numbers are even worse, down 1,495 individuals (-15.3%). Gage calls on Congress to step up and support the bipartisan Protecting America’s Seniors’ Access to Care Act, which would prevent CMS from enforcing this unfunded and flawed mandate.

“Together with our national association, the American Health Care Association (AHCA), we will continue to fight for more common-sense solutions and do everything we can to preserve access to care for Rhode Island seniors,” says Gage.

“The good news about the Biden Administration’s final rule, there are phase-ins over multiple years that will provide an opportunity to challenge the mandates through legislation and/or possible AHCA litigation on the national level,” adds Gage. “The federal mandate highlights how much of an outlier RI’s staffing mandate is.  The RI statute has the highest staffing metrics and the highest fines in the country – 10% above the federal standards.  Without the Executive Actions of Governor McKee, RI nursing homes would be fined $90 million in the first full year of enforcement – devastating facilities and forcing further closures.  RI excludes hours worked by administrative nurses from counting toward the RN metric, yet they are included in the federal standards.  RI also excludes med techs’ and nurse aides in training’s hours from the CNA metric, while CMS includes them,” noted Gage.

Gage adds that the CMS final rules consider Rhode Island to be “urban.” As a result, the state has 2 years to phase-in the 24×7 RN requirement.

Rhode Island regulations and law have required 24×7 RN coverage in nursing homes for many decades, says Gage. “While challenging to maintain compliance given the shortage of registered nurses, this should not be a major concern for RI facilities,” he adds, noting that there will be 3 years to comply with the required 0.55 HPRD for RNs and 2.45 HPRD for CNAs. 

Additionally, Gage says that there are also waiver opportunities in certain circumstances.  “During the implementation phase, facilities and all stakeholders must be laser-focused on building a sufficient pipeline of qualified nurses and CNAs to the nursing home workforce,” he says.  

Like Gage, James Nyberg, executive director LeadingAgeRI, sees the CMS mandate as less onerous than the RI staffing mandate that “fortunately” remains suspended. “We remain concerned about the impact of this national mandate on providers in Rhode Island, and its broader impact on consumers and the health care industry,” he says.

According to Nyberg, the state’s current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (six nursing homes have already closed since the COVID pandemic began and two more have embarked on significant downsizing). 

“These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes,” says Nyberg, noting that LeadingAgeRI is working with numerous stakeholders on various initiatives to develop a pipeline of workers. “But the simple fact is that it will take time and an infusion of resources,” he adds.

“CMS proposes to spend $75 million on a nursing home staffing campaign.  That amount might help a state like Rhode Island, but that money is national, so it is a drop in the bucket in terms of the support the industry needs, states Nyberg.  “On the home front, we have been working with the Administration and the General Assembly to provide an infusion of funding to try and rescue the homes from their dire financial straits and try to stabilize the industry.  But the federal mandate, and all the related details and requirements embedded in the rule, do nothing to further that cause,” he says.

For the Minimum Nursing Standard final rules, go to https://public-inspection.federalregister.gov/2024-08273.pdf

For the CMS Fact Sheet  on Minimum Nursing Standard final rules, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

Nursing home workforce crisis deepens with minimum staffing standards

Published in RINewsToday on February 13, 2023

“The long-term care industry is enduring the worst workforce crisis in its history, in Rhode Island, and across the country. Although providers are committed to recruiting and retaining staff to provide quality care for residents, despite our best efforts, many nursing homes have fallen short of the staffing ratio set by the RI Department of Health,” notes James Nyberg, Executive Director of the East Providence-based Leading Age Rhode Island (LARI), representing nonprofit providers of aging services.

“We are extremely  concerned about the impending fines that will be imposed on nursing homes here in Rhode Island as a result of our state’s existing nursing home minimum staffing ratio statute,” said Nyberg. Because of staffing ratio mandates, “the industry would have faced fines of over $11 million, in just one sample quarter (April – June 2022), since over 70% of nursing homes are not in compliance,” he said.  

“While April-June was a sample, the fines go into effect for July-September and we will receive a similar notice in just a few weeks, with only 10 days to pay the fine,” says Nyberg, stressing that these fines will only increase going forward if nursing homes are unable to meet the minimum staffing ratio.

Nyberg calls on the Rhode Island General Assembly to rescue Rhode Island’s nursing homes and provide relief from these penalties by delaying them and exploring an alternative approach to support the efforts of nursing homes to meet the ratio.  He warns that the current fine-based approach is excessive and counterproductive and will lead to reduced access to care and threaten the survival of the state’s nursing homes.

Nyberg points out that the current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (five nursing homes have already closed since the COVID pandemic began).  These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes.  

“We are working with numerous stakeholders on various initiatives to develop a pipeline of workers, but the simple fact is that it will take time.  In addition, as you know, the industry has faced years of underfunding from Medicaid, which pays for the majority of nursing home care.  This has made recruiting and retaining workers more difficult than ever,” says Nyberg. 

John Gage, President of the Rhode Island Health Care Association (RIHCA) agrees with Nyberg’s assessment of the nursing home workforce.  “Nursing homes across the nation are facing an historic labor shortage as the direct result of chronic Medicaid underfunding and the devastating impact of the Covid-19 pandemic on the workforce, he says, noting that the state’s nursing home workforce is down 20% since the start of the pandemic, with 2,000 workers lost from Jan. 2020 to June 2022.  Nationwide, the nursing home workforce is down 210,000 workers.

According to Gage, Rhode Island’s staffing mandate, while well-intentioned, will siphon tens of millions of dollars from resident care. In the first year of full implementation of the state’s minimum staffing mandate, RIHCA estimates that facilities will be fined upwards of $60 million. “These fines will imperil care, not bolster it,” he warns.  

Without legislative action, Rhode Island nursing homes will be fined an estimated $11 million on or about February 28, 2023, because of their inability to attract workers to meet the mandate from July 1, 2022, through September 30, 2022, Gage charges. “There are simply not enough available workers to fill the open staff positions, and resources are scarce.  Nursing homes will be devastated by these fines.  Facilities will reduce admissions, backing up hospital referrals and clogging hospital beds.  More nursing facilities will close – five have already closed since the beginning of the pandemic,” he predicts.  

Gage asks, “Who will care for Rhode Island’s frailest elders?” To recreate a minimum staffing mandate in nursing homes on the federal level would be a huge mistake, especially given the historic workforce crisis here in Rhode Island and nationwide,” he says.  

Gage’s comments echo concerns expressed by another group of US Senators in Jan. 20 correspondence (https://www.tester.senate.gov/wp-content/uploads/1-20-23-Nursing-Home-Staffing-Mandate-Letter-FINAL.pdf) sent to CMS by Senators John Bourasso, Jon Tester, and eleven other US Senators.  They caution the agency that a one-size fits all mandate would undermine access to care for patients, and they encouraged CMS to work with Congress on tailored solutions that address the workforce challenges facing nursing facilities.

At the federal level

Just days ago, U.S. Senators Bob Casey (D-PA), Chairman of the Senate Committee on Aging, and Ron Wyden (D-OR), Chairman of the Senate Finance Committee, called on the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to encourage the federal agency to establish minimum staffing standards in nursing homes to ensure high-quality care for nursing home residents. In Feb. 10 correspondence, Casey and Wyden, along with Senators Sherrod Brown (D-OH), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Cory Booker (D-NJ), and Elizabeth Warren (D-MA) urged CMS to advance the agency’s ongoing study to determine adequate staffing requirements in nursing homes.

“We appreciate the work that CMS has undertaken to promote safety and quality in nursing homes and applaud the Biden-Harris Administration’s commitment to protecting our nation’s seniors,” said the senators in Feb. 10 correspondence, urging CMS to “bring this work to completion.” 

“In our view, that means continuing the agency’s ongoing study to determine the level of staffing that is necessary to ensure safe and high-quality care for nursing home residents, developing an evidence-based and actionable proposal for mandatory minimum staffing levels, and a robust and transparent process—including direct stakeholder engagement— that will allow for further discussion and fine-tuning of requirements before the proposal is finalized,” wrote the senators.

The senators noted that studies have shown a correlation between inadequate staffing levels and lower quality of care. More recent studies have demonstrated that higher nurse staffing ratios mitigated the effect of COVID-19 outbreaks in nursing homes and resulted in fewer deaths. A recent Department of Health and Human Services Office of Inspector General report examining the high level of COVID-19 infections in nursing homes also pointed to the need for the establishment of minimum staffing requirements.  

In the correspondence, the senators cite the Social Security Act, which requires skilled nursing facilities to “provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents,” including the services of a registered nurse at least 8 consecutive hours per day, 7 days a week. The letter commends CMS for working to update this vague standard that has led to substantial variation in staffing levels and quality of patient care across facilities.

“Achieving the shared goal of ensuring quality care in nursing homes nationwide is a complex undertaking, says LeadingAge’s Ruth Katz, senior vice president, policy. LeadingAge is an association of nonprofit providers of aging services, including nursing homes.

“As our Get Real on Ratios proposal highlights, a number of conditions must be met in advance of any mandate implementation,” suggests Katz. “The senators correspondence to CMS is a promising development; it covers many of the same points as our Get Real on Ratios proposal – a recognition of the critical need for adequate reimbursement; that one size does not fit all, and that workforce shortages will need to be addressed with additional support. Without addressing these, staffing mandates are impossible. We look forward to continuing our discussions with Congressional leaders on this critical issue so that older adults and families can access much-needed care and services,” she says.

“The Senior Agenda Coalition of RI fully supports the need to develop national staffing standards to ensure quality care is provided to nursing home residents across our nation. It is important to note that Rhode Island has been a leader in this area. For many years our state has required 24/7 RN coverage in nursing homes and in 2021 the legislature passed the Nursing Home Staffing and Quality Care Act that includes staffing standards,” says Maureen Maigret, Policy Advisor to Senior Agenda Coalition of RI. “Now we must work to address workforce shortage issues and ensure that adequate government resources are provided especially through Medicaid payments so the standards can be met, and our critical direct care workers receive competitive living wages in order to keep them working in long term care,” she adds.

As the House Leadership hammers out the FY 2024 budget, it is crucial that adequate Medicaid funding is allocated to allow nursing homes to attract the necessary staff to meet the state’s minimum nursing standards that it codified into law. We must address this policy problem now rather than just kick the can down the road.