Nursing home admin wary of staffing minimums

Apr. 15—PLATTSBURGH — A local nursing home leader says new state requirements for staffing minimums could have unintended consequences on the continuum of care.

Meadowbrook Healthcare Administrator/CEO Paul Richards acknowledged that everyone wants quality care and services, but posited the new requirements, which went into effect April 1, do not solve staffing issues and could lead to bottlenecking at hospitals, lack of access to nursing homes and even closures of the facilities.

"It's stunning how tone deaf the legislators are, with every business having severe labor shortages," he told the Press-Republican.

3.5 HOURS PER DAY

In June 2021, former Gov. Andrew Cuomo signed a bill establishing the requirements, which specified that nursing homes were to maintain daily staffing hours equal to 3.5 hours per resident per day. Of those, at least 2.2 hours were to be provided by nursing assistants and 1.1 by licensed practical nurses or registered nurses.

According to the bill's memo, "compliance would be determined on a quarterly basis using existing staffing documentation required by the federal government," with mitigating factors such as disasters, emergencies, frequency and nature of non-compliance, and labor supply shortages to be considered when issuing penalties.

The law was set to go into effect Jan. 1, but was stayed by Gov. Kathy Hochul's administration in 30-day increments three times.

Under pressure from the 1199 SEIU union and state Attorney General Letitia James, whose office's report on undercounting of COVID-19 deaths in nursing homes preceded the staffing reforms, Hochul refrained from re-upping the suspension after March 31.

63% BELOW MINIMUM

But a March 2022 report conducted by CliftonLarsonAllen at the request of the New York State Health Facilities Association — of which Meadowbrook is a member — found 63% of New York facilities were below the 3.5-hour daily minimum, and estimated that it would cost $324.5 million annually and take 5,610 additional staff for them to meet it.

Based on Meadowbrook's current census, it is estimated the facility would need to either bring on 32 full-time nursing assistants or discharge 30 patients in order to comply, Richards said.

"And if, in fact, they are going to fine us, with a sliding scale of $300 a day to $2,000 a day, it's anywhere from $27,000 a quarter to $180,000 a quarter," he added. "Again, there just seems to be a disconnect."

LEADINGAGE LAWSUIT

The Clinton County Nursing Home is similarly concerned about the new requirements.

The Clinton County Legislature was set to vote on a resolution Wednesday evening authorizing the county, as the owner of the county nursing home, be named as a plaintiff in a LeadingAge New York lawsuit challenging both the minimum staffing levels and minimum direct care spending requirements.

The latter dictate nursing homes spend 70% of their revenue on direct care and 40% on resident-facing staff.

"I don't want everybody thinking this is (just) a Clinton County Nursing Home issue," County Administrator Michael Zurlo said. "This is a statewide issue."

Asked when DOH expected to hand down penalties and if the agency was considering waivers given reports that many nursing homes cannot meet the requirements, DOH spokesperson Jeffrey Hammond said nursing homes "should appropriately document their efforts to comply with the law."

"Mitigating factors can be considered by the department when assessing penalties for non-compliance at a later date."

MEDICAID REIMBURSEMENTS

Richards connected nursing homes' inability to meet the new staffing levels to inadequate Medicaid reimbursements from the state.

In a statement on the executive order putting the minimums in place, LeadingAge NY President/CEO James W. Clyne Jr. expressed a similar sentiment, criticizing the state's Medicaid rates for nursing homes as "abysmal," and saying they "do not allow our members to pay the wages we need to offer to compete for job applicants, even if such applicants were available."

Richards said Meadowbrook receives about $200 per day for its Medicaid residents, which computes to less than $8.50 an hour for 24-hour care and cannot keep up with what retailers pay.

He claimed New York State is number one in terms of the disparity between the cost of care and the Medicaid reimbursement amount. The latter figure would have to increase by about $75 per day "so that we can put our money where it belongs and that's to the phenomenal hardworking employees who care for these patients," he said.

"You have to significantly increase Medicaid reimbursements, and you have to start paying the nursing assistants $25 an hour. It's very difficult work."

'GRAY TSUNAMI'

Richards applies a long-term lens to addressing elderly care, and is already looking ahead to 2026.

At that time, he said, the baby boomer generation will begin hitting 80 years old — generally when people start to need nursing home care — and will do so by the thousands every day for the following 18 years.

"We need to start thinking out of the box to help pay for the care and the needs of this gray tsunami coming our way," Richards said.

In addition to increasing Medicaid reimbursements, he pointed to how a couple states are experimenting with a payroll tax that builds up funds for long-term care needs, whether that be for nursing home care, assisted living or home health.

"I'm hoping they (lawmakers) recognize that quality care demands proper payment," he reiterated.

Email Cara Chapman:

cchapman@pressrepublican.com

Twitter: @PPR_carachapman

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