Hill Event May 9, 2002

STAFFING IN THE SPOTLIGHT

The issue of staffing in nursing homes was the subject of attention at two events on Capitol Hill Thursday, May 9, 2002. At a morning press conference, U.S. representatives Jan Schakowsky (D-IL), Brad Carson (D-OK) and Eleanor Holmes Norton (D-DC) announced legislation to establish minimum staffing standards in the nation’s nursing homes. The legislation, called the “Nursing Home Improvement Act of 2002,” mandates that nursing homes comply with the Department of Health and Human Services (HHS) staffing levels for registered nurses, licensed nurses and certified nurse aides. These staffing levels would require that all nursing home residents receive between 4.1 and 4.85 hours of nursing care each day. Nursing homes would have two years to comply with the staffing levels. To pay for increased staffing, the bill would reinstate the Boren Amendment which, until its repeal by Congress in 1997, guaranteed “reasonable and adequate” Medicaid reimbursement for providing quality care. The bill also funds the additional staffing by increasing the federal Medicaid match to states for payment of health care services by 1.5%. To ensure that the increased federal resources are being used to hire additional nursing staff, the bill authorizes state inspectors to examine the financial records of nursing homes.

In making the announcement Rep. Schakowsky stated that while there have been important victories for residents in the past, such as the ombudsman programs and residents’ rights, the biggest challenge - understaffing - lies ahead.

The three Congressional representatives were joined by family members, advocates for nursing home reform and health care professionals. Two family caregivers, Belinda Clay and Nadene Mitcham, spoke about how their loved ones have been affected by the terrible problem of understaffing. Certified nursing assistant Jeannie Holley, told a compelling story about her experience with a resident who was dying. The resident had asked her to read a passage from her Bible. Holley was not able to do so because the facility was short staffed, and she had 13 other residents to care for that morning. By the time Holley was able to go back and check on the resident, she had already died. All Holley could do was cry.

At the press conference, National Citizens’ Coalition for Nursing Home Reform (NCCNHR) Board President Diane Menio presented Congress with the names of almost 100,000 voters from 49 states and the District of Columbia who are demanding adequate staffing in nursing homes. Signatures have been gathered from around the country over the past year. Menio also announced the publication of NCCNHR’s new book, “Nursing Home Staffing: A Guide for Residents, Families, Friends and Caregivers.”

Later in the day, a Congressional briefing on the Centers for Medicare & Medicaid (CMS) Staffing report was held. Speakers included Dr. Charlene Harrington, a researcher and expert on nursing home staffing; Dr. John Schnelle, co-author of the HHS staffing study; Florida State Representative Nancy Argenziano, sponsor of legislation in Florida to establish staffing standards for nursing homes; and Donna Lenhoff, NCCNHR Executive Director.

Dr. Harrington, who has studied the issue of nursing home quality care extensively, stated that the heart of the problem is inadequate federal staffing requirements. She said that current federal staffing standards are too vague and that nurse staffing reports need to be replaced with uniform, standardized and audited reporting. Dr. Schnelle discussed the results of the Phase II staffing study conducted for HHS. He pointed out there is clearly a link between staffing and quality. Significantly he said that recommendations for addressing the staffing problem by improving productivity, as laid out in the CMS report, only work if adequate minimum staffing is already present. Both Dr. Harrington and Dr. Schelle commented that numerous studies on staffing and quality have been conducted, and Dr. Harrington emphasized that no more research reports are needed on the relationship between staffing and quality.

Rep. Argenziano discussed how she became an advocate for nursing home reform and the steps that she went through in Florida to get a bill on staffing standards passed. The Florida bill calls for staffing to be increased to 4.4 hours of direct care by 2004. Rep Argenziano gained first hand knowledge of nursing home issues when she cared for a loved one in a nursing home for 5 years. She deepened her knowledge and understanding by visiting nursing homes in Florida with a local ombudsman. In fact, she was instrumental in passage of a bill that strengthened the Florida ombudsman program by providing more funding and giving the program more responsibility. Argenziano stressed that increased pay and respect for aides are essential and that there must be accountability if additional funding is given to nursing homes for staffing.

The final speaker, Ms. Lenhoff, stated that understaffing is a longstanding chronic problem in the country that needs a permanent answer, not a quick fix. Lenhoff noted that we have the research on the issue and know the solution; we now need to move forward.

For copies of the briefing or press packets, contact NCCNHR at 202-332-2275.