Bill poses burdens to RI’s nursing homes | #healthcare | #elderly | #seniors
Dr. David Gifford is chief medical officer of the American Health Care Association, Washington, D.C., and former director of the Rhode Island Department of Health, 2005-2011.
The COVID-19 pandemic has been devastating, particularly for the elderly who live and receive care in nursing homes. The pandemic exposed and exacerbated systemic issues in America’s long-term care system, notably workforce shortages and chronic underfunding.
The Rhode Island Nursing Home Staffing and Quality Care Act (HR 5012) creates a minimum staffing level of 3.58 hours of nursing care per day beginning in January 2022 and increases it to 3.81 in January 2023. It also provides a small Medicaid rate increase of 0.5% in 2022, or $1.2 million statewide, followed by 0.75% and 1% increases in the following two years.
On the face, this sounds like a good plan, as we all want more qualified, highly paid staff to take care of our parents and grandparents who need nursing home care. Unfortunately, the math in this bill does not add up. The Medicaid rate increases are well below the annual inflation rate. In addition, even as long-term care facilities begin to emerge from the pandemic, the additional costs of personal protective equipment, testing and enhanced infection control practices will remain as financial costs for the industry. Nationally, in 2020, nursing homes spent roughly $30 billion on personal protective equipment and additional staffing.
In addition, the bill restricts the use of the Medicaid rate increase to support such costs and requires that 80% of the rate increase must go toward increased staffing salaries. Using payroll data collected by the Center for Medicare and Medicaid Services (CMS) on the number of staff working in each Rhode Island nursing home, HR 5012 would require more than 815 new nurses to be hired by the 79 nursing homes in Rhode Island at an annual cost of $75.4 million when including salaries, benefits and payroll taxes. Yet, the proposed Medicaid rate increase is only $1.2 million, of which $975,000 must be dedicated to staffing, leaving only $244,000 for all 79 nursing homes in the state to address the increased annual costs, both existing and new, that have resulted from the pandemic. This is the definition of an unfunded mandate.
Even if the financing in this proposal is resolved, the bill does not recognize the enormous challenge of identifying an available workforce. It also does not increase funding for nurse training, nor does it make it easier for nurses to move to Rhode Island. In fact, the Rhode Island Department of Health gave up participation in the multi-state nursing compact, a program which allows nurses licensed in other states to more easily practice in Rhode Island.
A lesson learned during the pandemic was that when nursing homes were not made a priority, COVID-19 spread. If Rhode Island policymakers are serious about making nursing homes a priority, they not only must provide adequate funding to hire the necessary staff, but they need to make it easier for long-term-care providers to train and recruit staff.