For 18th straight year, House and Senate committees reject nursing home staffing mandates

This wasn’t the first time lawmakers have rejected a request for minimum staffing requirements at Virginia nursing homes.

But Tuesday’s vote by a House panel to kill legislation to raise labor standards has been particularly frustrating for advocates amid the ongoing COVID-19 pandemic, which has contributed to more than 4,700 deaths in state long-term care facilities. A Senate committee rejected similar legislation last week, ending any hope of passing personnel requirements at this year’s General Assembly session.

Lawmakers rejected the initiative to nearly two decadesbut the last votes came despite one year of intensive study on the subject by Virginia’s Joint Commission on Health Care, a permanent working group dedicated to policy analysis. The Commission final report listed staffing mandates as one of the top policy options for improving quality in public facilities, which rank below the national average for care.

Nationally, 31% of nursing homes have a staffing rating of one or two stars — the lowest possible rating — from the US Centers for Medicare & Medicaid Services. In Virginia, 43% of facilities are rated one or two stars, a rating based on the expected number of direct care hours needed to support residents.

According to the report, more than 60% of low-staff facilities in Virginia also receive poor health inspection ratings, and understaffing is worse in nursing homes with high proportions of low-income and black residents, who are disproportionately likely to be enrolled in Medicaid.

“I do my best to put a face to it,” Del said. Vivian Watts, D-Fairfax, whose latest bill marked her 18th attempt to pass personnel requirements through the General Assembly. “We are concerned about people who cannot afford basic care.”

Of the. Vivian Watts, D-Fairfax. (Photo by Ned Oliver/Virginia Mercury)

Its legislation this year mirrored a Senate bill sponsored by Senator George Barker, D-Fairfax – both drafted based on recommendations approved by legislative members from

Joint Commission on Health Care in December. The proposed legislation would have required care homes to provide – at a minimum – the benchmark number of direct nursing hours calculated by the CMS based on the needs and condition of the residents living there.

The bills would also have introduced penalties of up to $10,000 per violation for facilities that fail to comply with the new requirements. As written, these sanctions would only come into effect if the state budget funded at least the initial administrative costs of implementing the legislation, which also provided a new state fund for all fees charged to retirement homes. Over time, the money would have been used for facility quality improvement grants and to help pay for the running costs of the program, according to the tax impact statement for the bill.

Of the. Betsy Carr, D-Richmond, also introduced another bill that would have set fixed hourly staffing requirements across all areas rather than adjusting terms based on estimated need. His version has been favored by consumer advocates for several reasons, including concerns that the formula currently used by CMS to calculate resident acuity does not accurately capture some of the neediest patients at many facilities.

“The case mix they use doesn’t even take into account the staff needed to prevent harm – it focuses on how long it takes staff to perform certain actions,” said Emily Hardy, a senior Virginia Poverty attorney. Law Center. Joani Latimer, who serves as a patient advocate as Virginia’s long-term care ombudsman, also said the facility-specific requirements would be difficult for residents and their families to parse.

“I think there’s tremendous value in an hourly standard because it just translates more clearly,” she said. “I’m very concerned that relying on acuity just isn’t something people could master. And then, it is difficult to know if your installation is compliant.

The death toll from COVID-19 at Canterbury Rehabilitation and Healthcare Center in Henrico became one of the highest in the country at a long-term care facility in April 2020. (NBC12)

Distinctions between invoices, however, ultimately mattered less than concerns about expected cost. Long-term care industry lobbyists have opposed efforts to introduce staffing minimums for years, arguing that chronic labor shortages would affect their ability to hire the employees needed to meet the new standards. They also argued that compliance would require larger reimbursements from the state’s Medicaid program, which pays the majority of patients at most facilities.

“We’re facing two hurricane headwinds – we don’t have Medicaid reimbursement to pay people and when we look at staff, we don’t have people in the bullpen lined up to hire them. “said Scott Johnson. , a lobbyist for the Virginia Health Care Association. Carr’s legislation proposed a phased introduction of staffing minimums, but all three bills included massive cost estimates for the state. One called for the state to pay up to $100 million more by the end of the decade to reimburse the facilities for increased staffing costs.

Advocates, however, have long argued that the estimated costs reflect decades of underfunding within Virginia’s Medicaid program. And while the state will begin offering additional reimbursements this summer to facilities that meet certain quality measures, there is still no requirement for nursing homes to take advantage of the program – leaving many residents stuck with a insufficient staff.

“It’s absolutely outrageous that they can’t act on this,” said Natalie Snider, state advocacy director for AARP Virginia. “We are talking about Virginians who are incredibly fragile. And the fact that our General Assembly says no year after year is simply unacceptable.

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