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EDITORIAL: Staffing-level mandate is wrong approach to keeping nursing homes safe
Buffalo News - 12/20/2018
Dec. 20--There is no question that having good patient outcomes at nursing homes correlates with the number of staff members working there. More is better.
It might follow, then, that a bill called the Safe Staffing for Quality Care Act, which mandates minimum staffing levels at nursing homes and hospitals, would be the way to ensure that the residents are well taken care of. It's not that simple. The well-intentioned legislation, by forcing nursing homes to allocate their financial resources in a prescribed way, would stymie innovation and take away some of the operators' discretion in allocating resources to best take care of their residents.
The Assembly passed the Safe Staffing for Quality Care Act in 2016, but it did not get out of committee in the Republican-controlled Senate. Last month's elections, however, tilted the Senate to Democratic control when the new session starts in January, and the bill is expected to pick up fresh support.
The staffing legislation has the support of the Service Employees International Union, a major donor to politicians across the state. It is opposed by trade groups representing nursing home operators and hospitals. They maintain the staffing mandates would cost an extra $1 billion annually in New York, with the increase passed to consumers through higher Medicaid payments.
The act would require nursing homes and hospitals to maintain specific minimum staffing ratios for nurses and certified nursing assistants. Each home's RNs, CNAs and licensed practical nurses would have to spend a total of 291 minutes a day with each resident, on average.
Just 8 percent of the 619 nursing homes in New York State now meet that standard, and there is just one that meets the requirement in Erie or Niagara County -- HighPointe on Michigan, in Buffalo. (That facility has had some other struggles, outlined in a story in Sunday's Buffalo News.)
There is a legitimate role for government to play in regulating long-term care facilities. And while everyone is in favor of safe staffing, there are better ways to accomplish that than by having a simple mandate on nursing hours.
Nursing homes are evaluated by state health officials and the federal government on many different metrics, including clinical outcomes, staffing levels and the number of complaints or violations they accrue.
Regulators should focus on making poorly performing nursing homes clean up their act or else be forced to shut their doors.
In a conversation with The News last July about the safe staffing bill, F. James McGuire, president and CEO of the Maguire Group, which operates five nursing homes in Western New York, voiced his concerns.
"I don't think a legislator is best equipped to determine the right mix of RNs, LPNs, nurse practitioners, physical therapists, occupational therapists, and all of the clinical disciplines involved in caring for a patient," he said.
Nursing home operators should be allowed to try different combinations of medical staff and caregivers in determining the best way to guard their residents' health and well-being.
If less scrupulous operators put profits above their residents' welfare, the state should lean on them.
Nursing homes' Medicaid scores aren't like an online restaurant review -- there is too much at stake. For the federal ratings to have teeth, regulators need to monitor them closely and turn up the pressure on long-term care facilities that aren't serving their clients' needs.
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