Tag Archives for Senator Jon Tester

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.

Trump Signs Legislation to Undo Nation’s Banking Rules

Published in the Woonsocket Call on May 27, 2018

On May 22, 2018, The Senior Safe Act, a bipartisan bill authored by U.S. Senators Susan Collins (R-ME) and Claire McCaskill (D-MO) to help protect older American’s from financial exploitation and fraud, passed the House of Representatives by a vote of 258-159 as part of a bipartisan banking reform package after previously passing the Senate in March by a vote of 67-31. President Donald J. Trump’s signed the bill into law rolling back regulatory oversight of the nation’s financial industry.

The Senior Safety Act is part of S. 2155, the “Economic Growth, Regulatory Relief and Consumer Protection Act,” a bill that modified the provisions of the Dodd-Frank Act, which was passed by Congress in 2010 to oversee the financial industry after the financial crash and recession of 2008-09.

Protecting Older Investors from Financial Exploitation

Through the watchdog efforts of the Senate Aging Committee, financial exploitation of seniors was identified as a top senior issue to combat. According to the Government Accountability Office, financial fraud targeting older Americans is a growing epidemic that costs seniors an estimated $2.9 billion annually. These frauds range from the “Jamaican Lottery Scam,” to the IRS impersonation scam, to the financial exploitation of seniors through guardianships. Earlier this year a hearing was held to update the public about the committee’s efforts to combat scams targeting older Americans as well as unveil its 2018.

As the Chairman and former Ranking Member of the Senate Special Committee on Aging, Senators Collins and McCaskill introduced the Senior $afe Act last year. Existing bank privacy laws can make it difficult for financial institutions to report suspected fraud to the proper authorities. The Senior $afe Act address this problem by encouraging banks, credit unions, investment advisors, broker-dealers, insurance companies and insurance agencies to report suspected senor financial fraud. It also protects these institutions from being sued for making reports so long as they have trained their employees and make reports in good faith and on a reasonable basis to the proper authorities.

“As Chairman of the Senate Aging Committee, I have been committed to fighting fraud and financial exploitation targeted at older Americans,” said Senator Collins. “The Senior $afe Act, based on Maine’s innovative program, will empower and encourage our financial service representatives to identify warning signs of common scams and help prevent seniors from becoming victims.”

Judith M. Shaw, Maine Securities Administrator and chair of the North American Securities Administrators Association’s Committee on Senior Issues and Diminished Capacity, says that this legislation incentivizes financial service institutions, including those in the securities industry, to train key employees on the identification and reporting of suspected financial exploitation of seniors. “This is a significant and important tool in the ongoing efforts to protect senior investors,” she adds.

Adds Jaye L. Martin, Executive Director of Legal Services for the Elderly, “We know from our proven success with Senior Safe in Maine that education of financial services professionals is a key component to identifying and stopping financial exploitation of seniors. There is no doubt this bill will help prevent seniors all over the country from becoming victims.”

With the passage of S. 2155, Keith Gillies, President of the National Association of Insurance and Financial Advisors (NAIFA), said, “The Senior Safe Act provides “much needed protection for older investors and will allow advisors to better protect their clients’ interests.”

“Advisors are often the first line of defense for scammers looking to take advantage of investors,” says Gillies, noting that studies have found older Americans are often a prime target.

The Pros and Cons of S. 2155

Since the Dodd-Frank legislation’s passage eight years ago, 20 percent of small banks have been put out of business, said President Trump and a ceremony where he signed S. 2155 into law. He predicted that the roll back of the costly banking reform regulations, both “crippling” and “crushing” to community banks and credit unions, would stimulate the banking industry to increase lending to businesses.

Banking regulations made it virtually impossible for new banks to be established to replace those that had closed their doors, said Trump, denying small businesses with access to capital. “By liberating small banks from excessive bureaucracy — and that’s what it was: bureaucracy — we are unleashing the economic potential of our people,” said Trump.

Senator Jon Tester (D-Montana) calls the Economic Growth, Regulatory Relief, and Consumer Protection Act a jobs bill, saying “it is a much-needed solution for the folks who power our local economies.”

In an op-ed in the Greater Fort Wayne Business Weekly, Senator Joe Donnelly (D-Indiana) said, “This banking package is reasonable, balanced, and the result of thoughtful negotiation and compromise. It would take measured steps to encourage community financial institutions to boost lending and provide new protections for consumers. And it’s an example of what we can achieve when we work together to break the gridlock in Washington.”

But others strongly oppose passage of S. 2155.

Although S. 2155 has a provision to protect seniors from financial exploitation, Democratic Policy and Communications Committee Co-Chair David N. Cicilline, expressed strong concerns when the Houses passed S. 2155, he jokingly refers to as “the Bank Lobbyist Act.”

“Ten years ago, Wall Street’s recklessness brought our economy to the brink of collapse. It has taken Rhode Island years to recover. In many ways, we are still recovering.,” noted Rhode Island’s Congressman representing District 1. “The Dodd-Frank financial reform law ended the worst of the Big Banks’ excesses. It established the Consumer Financial Protection Bureau and gave working people a voice against the most powerful corporations in our country,” he said, noting that the passing of S. 2155 has reversed this progress.

It’s a massive giveaway to the wealthy and the middle class is getting screwed. This is a raw deal for working men and women. The American people deserve A Better Deal,” Cicilline said.

Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, warns that with the deregulation of banks, the GOP “are still gunning for Social Security under the guise of entitlement reform.”

Richtman predicts the passage of S. 2155 and it’s signing into law “makes another financial crisis more likely.”” He asks, “How fair is it to ask workers to be responsible and save when the government strips away protections intended to keep our savings secure?”

“Retirees’ Social Security benefits must be preserved because, at least for now, they are the only thing workers can depend on after the next financial crash,” says Richtman.

The Senior $afe Act was endorsed by organizations, including AARP, the North American Securities Administrators Association (NASAA), the Conference of State Bank Supervisors (CSBS), the Credit Union National Association (CUNA), the National Association of Federally-Insured Credit Unions (NAFCU), the National Association of Insurance Commissioners (NAIC), the National Association of Insurance and Financial Advisors (NAIFA), the Securities Industry and Financial Markets Association (SIFMA), the Insured Retirement Institute (IRI), Transamerica, and LPL Financial.