A study released today by Service Employees International Union (SEIU) Healthcare PA found that Pennsylvania nursing homes generated $511 million in net income for 2011, but one in three failed to fully spend state funds on direct resident care.
State Senators Matt Smith (D-Allegheny / Washington) and Sean Wiley (D-Erie) proposed three bills that would mandate minimum spending levels of state appropriations as well as require nursing homes to meet and report on staffing levels.
“This really just focuses attention and requires that public tax dollars be used to the end that they’re supposed to be used for, which is that direct resident care,” said Smith.
According to the Centers for Disease Control and Prevention, approximately 1.5 million U.S. seniors live in nursing homes. Nursing home staff is typically comprised of registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse aides (CNAs) who help residents shower, use the bathroom, or change position in bed.
Nursing homes see high turnover rates, and often operate short-staffed, said Yeta Oketh, a Harrisburg-based CNA. It is hard work, and work that requires as much emotional energy as it does physical stamina. Oketh said caring for the elderly is like caring for a baby. “Except now it’s a full-grown but fragile adult.”
According to Wiley's legislative director Scott McLean numerous studies point to the relationship between staffing and quality of care. "In particular, CNA hours per resident per day are strongly associated with better scores on certain quality measures, as well as lower hospitalization of residents.”
However, McLean added, there is no minimum requirement for CNA staffing.
Legislation to mandate staffing, use of state tax dollars
Senate Bill 624, sponsored by Wiley, would require all nursing homes to meet a minimum CNA staffing level of 2.15 hours of direct care per resident per day.
Questions of appropriate staffing levels relate directly to nursing homes’ use of funds, and particularly state tax dollars.
According to Dennis Short, the director of SEIU’s study, the nursing home industry has argued at both federal and state levels that they lose money when providing care for Medicaid residents,
If nursing homes regularly lose money on Medicaid patients, providing care at cost to themselves, Short wondered why a nursing home wouldn’t make full use of state-provided dollars.
He said the point of the study was not to discover how untapped state funds might have boosted the overall profitability of a nursing home. Instead, SEIU Healthcare PA sought to explore the relation between higher spending and quality of care.
“Folks who are spending above a certain threshold are seeing higher, better outcomes. You’ve got better staffing levels, better quality measures, and fewer deficiencies,” said Short.
Senate Bills 625 and 626, sponsored by Smith, would require nursing homes to report staffing levels and turnover rates to the Department of Health, and to spend a minimum of 95 percent of their Medicaid per diem on direct resident care. Staffing and turnover reports would be made available to the public to enable families to make an informed nursing home choice.
“These are our seniors that we’re caring for, and they deserve the highest level of care that they can get,” said Short. “If the end result is that people have less profit, we’re OK with that.”