Raimondo's Unfunded Staffing Mandates Will Close Nursing Homes, Says RI Healthcare Association
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Raimondo's Unfunded Staffing Mandates Will Close Nursing Homes, Says RI Healthcare Association
According to RICHA, the immediate inclusion of the policy in regulation "circumvents the legislative and hearing processes and implements a long-fought about policy on unfunded mandatory staffing hours by calling it an emergency provision under the pandemic. Nursing homes say it will put a number of homes out of business and decimate others, driving quality down."
“No hearings, no public input and no transparency around this highly impactful policy,” said RIHCA President and CEO Scott Fraser. “The governor’s oft-mentioned claim she is laser-focused on nursing homes and the care of our elderly residents is misleading the public. We need Rhode Islanders to know, it’s simply not the case.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTThe nursing homes have lobbied against unfunded mandatory staffing hours promoted by the Service Employees International Union (SEIU) for the entirety of 2020 showcasing what they say would be the detrimental effect the mandate would have on the homes that care for the most frail in the community.
"News of the proposed regulation came without any dollars to support it; and at an estimated cost of $75 million per year, according to an analysis by the American Health Care Association," said RIHCA. "Its implementation will reduce quality in the homes, not enhance it."
About Mandate
RIHCA released the following on Wednesday:
The 3.8 hour mandate would be the highest of all the states in the nation and is being put forward with zero dollars in funding. Staffing mandates are arbitrary across the 50 states with twenty-five states having no mandate and twenty-five implementing mandates averaging 2.5.
Massachusetts is considering adding a mandate into regulation after months of hearings and testimony. The proposed regulation is a 3.58 hour mandate; however it is also made possible by $90 million in funds. This is unlike RI’s unfunded regulation.
Across the country, states with lower or no mandates such as CT and RI show up in the top 25 states for quality. Hawaii and Maine, with no mandates, are number one and two, the highest states in the
CMS’ five star rating system. (RI was ranked number two in the country in quality by the American Senior Rankings Report in 2019). On the contrary, those with higher mandates have earned mixed reviews including Vermont who shows up at number 28 in quality.
Why is a staffing mandate with no accompanying funds a significant burden on nursing homes?
1. Deep and consistent cuts to Medicaid by the state since 2012 combined with the UHIP failures have left many homes teetering on the edge.
Despite a 2012 law mandating Medicaid reimbursement be paid with an inflationary adjustment of approximately three percent a year, Medicaid has been cut each year since but one. In every year she has been in office, Governor Raimondo has proposed cutting Medicaid, including a $7.5 million cut in the FY ‘20-21 budget – creating a $50 million deficit in this years’ budget alone. In total, hundreds of millions have been cut since 2012 and the nursing homes have been operating on fumes to care for the most vulnerable population in the state. Two-thirds of all residents are paid for by Medicaid.
To top all of this, the Governor’s premier UHIP program which was supposed to make the healthcare system much easier for providers instead took millions from their operations. With payments for some Medicaid residents taking more than three years, and others being lost in the system, nursing homes have been left to care for residents with no funds to reimburse them.
“Adding $75 million in mandatory spending annually to a health care system already suffering economically is irresponsible,” said Fraser.
2. A state nursing home staffing crisis is already in play resulting in overworked staff who have been on-call since March.
As Governor Raimondo herself has found out in trying to staff the state’s field hospitals – there are no healthcare staff to hire. This has been the plight of the nursing homes for some time. The cuts in Medicaid reimbursement year after year, have kept wages far too low for nursing home workers and left hundreds of nursing home jobs vacant.
Despite constant requests to the state for assistance, Medicaid continued to be cut and workers went elsewhere for jobs during the more robust economic times. This left the nursing homes already stretched for staff before the pandemic, and with the onset of the virus, still more workers have retired or stayed home for fear of catching or carrying the virus, or knowing they had a vulnerable family member at home.
This, on top of large numbers of staff testing positive and needing to be kept out of work for weeks at a time, have left nursing homes in a place where they must get staff from agencies at an incredibly-high rate.
“Those continuing to work in the homes are overworked and underpaid. The governor continues to call them heroes, while doing nothing to support them. And a small, temporary raise for two weeks in a pandemic, doesn’t cut it,” Fraser said. “Now she’s putting their jobs on the line by implementing a policy that could close homes.”
He continued, “The state itself is now offering astronomical wages ($45 - $105/hour for CNA’s and nurses) for healthcare workers to work in the field hospitals, leaving nursing homes further behind with no way to compete for existing staff.”
3. The high cost of the pandemic has placed the nursing homes at ground zero with little state support.
From the cost of PPE, to single rooms, isolation costs and cleaning and maintenance, these nursing homes have been paying out much and getting little back. The nursing homes have been heroically taking care of frail seniors at this difficult time.
The aforementioned reasons of high costs, no available additional staffing and little assistance have put the nursing homes in a precarious financial situation, making a $75 million annual unfunded staffing mandate an impossible regulation to implement.
Dr. Alexander Scott herself, said the policy was not implementable.
In a letter dated July 13, 2020, written in support of the mandatory staffing legislation, she stated: “For minimum staffing standards to be successfully implemented, sufficient data must be available to establish meaningful metrics around minimum staffing, there must be a sustained pool of nursing staff (RNs, LPNs, CNAs) from which to hire, and appropriate financing must be made available to support them.”
Fraser concluded, “In her July 13 letter supporting mandatory staffing hours, Dr. Alexander Scott herself put forward conditions that must be met in order for staffing standards to be implemented successfully: ‘sufficient data,’ ‘a sustained pool of nursing staff,’ and ‘appropriate financing…to support them.’ Not one of these conditions has been met,” Fraser said. “Pushing a 3.8 unfunded mandatory staffing policy into regulation in the midst of a pandemic when nursing homes are already at a breaking point is irresponsible.”