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Nursing Home Legislation and Mandatory Staffing Levels

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Nursing Home Legislation and Mandatory Staffing Levels

Stark and Schakowsky

(Best Syndication News) On Friday, September 26, 2008, Reps. Pete Stark and Jan Schakowsky introduced the "Nursing Home Transparency and Quality of Care Improvement Act of 2008."

The bill increases the transparency of nursing home ownership, ensures that residents and their families have information about the quality of care at these facilities, and strengthens enforcement of nursing home compliance with quality of care standards. It is a companion bill to S. 2641, introduced by Senators Charles Grassley and Herb Kohl.

The Nursing Home Act enables nursing home residents and government regulators to better know who actually owns the nursing home and who controls the decision-making that impacts the quality of care provided. In addition, the bill improves the reporting of information on staffing levels and direct patient care expenditures.

In addition to increasing transparency, the bill takes additional steps to improve the quality of care. The bill puts patients first, by requiring advance notice of home closures, standardizing the nursing home complaint process, and establishing specific processes and consumer protections for complaint resolution.

The bill also improves staff training to include dementia management and abuse training as part of pre-employment training. The bill improves accountability and enforcement by mandating that homes establish compulsory ethics and compliance programs, making civil monetary penalties more meaningful, and studying the feasibility of new independent monitoring requirements.

While the bill proposes collecting accurate information about nurse staffing by comparing it with payroll records, mandatory staffing levels is not in the nursing home bill.

Many states fought twenty world-wars to get mandatory staffing levels, even then, it was constantly being attacked. In one state, when there was a possibility of cutting Medicaid funding, the industry jumped at the chance to use that funding cut as an excuse to abandon the staffing level requirements.

Federal law only requires nursing homes to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident, and we know this is insufficient.

There have been numerous federal bills requiring various mandatory staffing levels, only to be defeated or die on the vine. Now is the time for those mandatory staffing levels. The biggest problem with staffing is that the industry will not allow it to happen unless it's tied to additional taxpayer funding (and the current economy will be the biggest weapon as to why taxpayers can't afford it).

Most importantly, the only way additional funding should ever be allowed is if every red cent of it goes directly to hands-on caregivers, no one else. There have been instances where taxpayer funding for nursing homes has been raised, but it did not translate into those dollars going solely to the hiring/training of more hands-on staff.

The lack of staffing can be explained in simplified terms, right down to the basic facts that, without it, patients don't receive even basic humane care; i.e., fed, hydrated, changed, bathed, turned, given their meds on time and/or given correctly. Lack of staffing, in turn, creates a constant high turnover among even the most highly-trained, dedicated workers.

Patients lose weight and some starve to death because no one helps them eat or leaves the tray at bedside, out of reach; same thing with drinking fluids; subjected to the humuliation of soiling themselves, often just because no one assists them to the bathroom, and such lack of hygiene also creates physical problems as well, from skin breakdown all the way to deadly, septic pressure sores.

This lack of care also translates into even more taxpayer dollars down the drain because the health problems that result from the lack of staff means costly hospitalizations, surgeries, and/or other medical treatments and/or medications that wouldn't have been necessary.

The problem with nursing home inspections is they depend on paperwork to verify residents are getting good care. However, surveyors look at self-reported and unaudited data (data reported by the facilities themselves and no over sight agency verifies audits to ensure it is even true. This leads nursing staff to do charting by rote, they are not charting care that they're actually giving.

Repeated findings by the Government Accountability Office have shown that self-reported data makes nursing home quality appear to be better than it actually is. It focuses on structure and process measures, not on whether residents actually get appropriate care.

In addition, the nursing home has nurses on staff to make sure the paperwork is perfect, thereby ensuring a good inspection. Because of a lack of nursing staff, nurses are ignoring signs that a resident's condition is deteriorating until the resident is in a medical crisis. Licensed staff is not doing the critical thinking to keep these things in check.

Neglect is the silent killer in nursing homes. By some estimates, malnutrition, dehydration, bedsores and infection - caused by neglect - account for half of nursing home deaths and injuries.

This nation needs to write or call their federal congressional delegation to be on the ground floor at getting this much needed legislation passed.

By Gregory D. Pawelski

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