Anyone who has visited a nursing home on a Saturday or Sunday knows that the staffing levels seem thin, as call buttons go unanswered while nurses and aides try to keep up with their patients’ needs. A story on Sunday from Kaiser Health News and the New York Times highlighted the fact that many nursing homes nationwide in the past decade have been exaggerating their staffing levels in reports to the government, and not properly identifying their low staffing on weekends.
The New York State Nurses Association has been lobbying for a bill in Albany called the Safe Staffing for Quality Care Act. The bill passed the Assembly but has been held up in the Senate, where it has not gotten out of committee. The bill would mandate minimum staffing ratios of nurses to patients in hospitals and nursing homes. While the goal of improving patient care is admirable, the legislation’s focus on nursing ratios seems too narrow. There are other ways to meet the urgent task of ensuring that nursing home residents are kept safe and are not neglected.
Staffing is always a concern in long-term care facilities. The New York Times report included the fact that on the days with lowest staffing at an average facility, the personnel on duty cared for nearly twice as many residents as they did when staffing was at its fullest.
In late June, some 50 union workers held a demonstration over safety and staffing issues outside a Buffalo nursing home, Emerald South Nursing & Rehabilitation Center on Delaware Avenue. A resident of Emerald South had fallen to his death at the facility in June, apparently while trying to escape.
On the day of the demonstration, Assemblywoman Monica Wallace, D-Cheektowaga, spoke up in favor of the “safe staffing” bill, which would place a cap on the number of residents that nurses and certified nurses’ aides are assigned.
“These workers do a challenging and thankless job, often for minimal wages,” Wallace said. “The work is physically and emotionally draining.”
She is right, of course. But there is also more to it.
F. James Maguire is president and CEO of the Maguire Group, which operates five nursing homes in Western New York that have traditionally earned high ratings for their levels of care. Maguire agrees that patient care presents special challenges, but he doesn’t think the bill circulating in Albany is the answer.
“Whether it’s a dementia patient with Alzheimer’s or another clinically complex patient, the kind of care that’s most appropriate for that patient is going to vary,” McGuire says. “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.”
McGuire points out, rightly, that the state needs to do a better job of policing and disciplining care facilities that consistently fall short in ratings for patient care.
“If you look at clinical outcomes and quality of care, those are the issues that should be most important to families,” McGuire says. “If facilities can do that efficiently and with a different mix of staff skills, then so be it.
“Truly what they’ve done for so long is let very marginal facilities continue to operate without any meaningful consequences ... I think fundamentally what they need to do is start enforcing some metrics on quality.”
It’s a sad reality that the phrase “overworked nurses” is practically redundant. And the hiring and retention of caregivers is particularly challenging in nursing homes, whose economics keeps them from offering salaries equivalent to traditional hospitals.
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.