NC lawmakers vow to address nursing home staffing crisis. ‘The alarm bell has rung.’

More staff. More money. More inspections. More accountability.

Top North Carolina officials say those are among the fixes needed to address a staffing crisis that endangers thousands of nursing home residents in this state..

Left Alone, a recent Charlotte Observer investigation, documented how a shortage of caregivers inside nursing homes puts vulnerable residents at risk of neglect.

Asked about the Observer’s findings, Gov. Roy Cooper said he and his staff are “deeply concerned about what’s happened in nursing homes.”

“It is critical that we invest in making sure that these seniors are taken care of and we want to continue to work to do that,” Cooper said during a visit to Charlotte this month.

Dave Richard, deputy secretary for Medicaid at the state Department of Health and Human Services, said he’s talking with legislative leaders about a need to give nursing homes a financial incentive to provide higher-quality care.

Legislators on influential committees say they understand the importance of responding to the crisis, but they don’t always agree on the solutions. Among the points of contention: whether to impose more rules on North Carolina’s nursing homes, 80% of which are owned by for-profit companies.

“Any society that doesn’t take care of its young or its elderly - it’s a poor reflection on the society,” said state Rep. Larry Potts, a Republican from Davidson County who co-chairs the House health committee - one of the key panels likely to discuss nursing home measures.

The toll of poor care hit close to home for Potts this year. During a winter storm in January, police officers responded to a 911 call from a patient inside a nursing home in his district. When officers arrived at Pine Ridge Health and Rehabilitation Center in Thomasville, they found two patients dead and two in critical condition.

They also found residents distraught over not receiving meals and medications; an exhausted nurse aide who suffered a panic attack; and unattended patients in the dementia unit. Just three staff members were present to care for 98 residents, police said.

(Read Left Alone, the Charlotte Observer’s investigation into patient neglect linked to staffing shortages inside North Carolina nursing homes .)

Will more money help?

While nursing homes nationwide are struggling to hire and hold on to caregivers, few states have problems as severe as North Carolina, where 80% of nursing homes are for-profit, the Observer found.

Only about one of every five North Carolina nursing homes meet the staffing threshold recommended by a landmark federal study. That helps explain why nursing homes here log lower average quality scores than 43 other states, experts say.

Low pay and difficult work conditions have made it tough for nursing homes to attract and retain caregivers. Even with pay rising for some during the pandemic, most certified nursing assistants in North Carolina nursing homes still earn less than $16 an hour — a lower minimum wage than Costco now offers.

Nursing home leaders blame North Carolina’s low rate of Medicaid reimbursement for nursing home care, which they say limits what facilities can afford to pay employees.

State leaders have taken some steps to respond. This year, direct care workers collected bonuses of nearly $2,000 from the state. The legislature also approved additional Medicaid payments to nursing homes during the pandemic.

But that funding is set to expire at the end of June. Unless the legislature approves Medicaid increases, “we’ll exacerbate the crisis” said Richard, the health and human services deputy secretary.

“The first thing I’d do is increase that reimbursement rate so nursing homes have the ability to pay enough to hire employees,” said Sen. Jim Perry, who co-chairs the committees on health care and health and human services appropriations. “...It is going to be expensive. That is just what it is going to require.”

Should money be tied to quality?

To date, there have been few strings attached to the Medicaid money that nursing homes receive. They’re not, for instance, required to spend a percentage of those funds on direct care workers.

Richard said change is needed. “Ultimately, we need to start tying pay to quality,” he said.

A law passed in New York last year requires nursing homes to spend at least 70% of their revenue on direct resident care.

That’s in line with a new study by the National Academies of Science, Engineering and Medicine, which urges sweeping changes to how nursing home care is delivered, financed and regulated in the U.S. The 604-page report recommends that a specific percentage of nursing home Medicare and Medicaid payments be designated to pay for direct-care services for residents.

Dr. Philip Sloane, a nursing home expert at UNC-Chapel Hill who contributed to the report, said nursing homes clearly need more money, but they also should be required to spend most of it on direct patient care.

“There has to be some accountability so that facilities don’t game the system,” said Sloane, who serves as Co-Director of the Program on Aging, Disability, and Long-Term Care at UNC’s Cecil G. Sheps Center for Health Services Research.

Perry said New York’s approach was “not an unreasonable idea.”

Not all North Carolina lawmakers agree with him. Sen. Jim Burgin, who co-chairs the Senate Health Care and Appropriations on Health and Human Services committees, said he opposes such requirements.

“I think we have too much government now,” he said. “...Government can overreact on some things.”

Should NC set staffing rules?

More than 30 states have imposed minimum staffing ratios for nursing homes. But North Carolina isn’t among them. That allows homes here to operate with minimal staffing.

The federal government has not set minimum staffing ratios either, but that may change. During his March 1 State of the Union address, President Biden said he wants to set higher nursing home standards. The federal Centers for Medicare and Medicaid Services will propose minimum staffing standards within a year, the White House said.

Richard, the DHHS deputy secretary, said he thinks the state should await the federal government’s recommendation on minimum staffing requirements.

But Marilynn Lester is among those who say North Carolina shouldn’t wait for the federal government. Her mother, Ruth, died from sepsis at a short-staffed nursing home in Cornelius last year. Lester blames the nursing home, which she believes failed to do adequate follow-up care to ensure a urinary tract infection cleared up.

Staffing shortages at nursing homes like her mother’s result in the sort of neglect that can cause residents to suffer and die, she said.

“People aren’t getting their medicine on time,” she said. “People can develop infections. People can develop bed sores. The nursing home may not have resources to give them water.”

Time to lift COVID legal shield?

The Observer’s investigation found that state lawmakers and federal regulators removed key protections for residents during the pandemic by sharply curtailing inspections and shielding homes from COVID-19-related lawsuits.

In May 2020, the state enacted a law that protected nursing homes and other health care providers from liability for decisions or activities “directly or indirectly” related to the COVID-19 pandemic.

But plaintiff’s attorneys and advocates for nursing home residents say North Carolina’s law has impeded efforts by families to hold nursing homes accountable for actions and negligence that have nothing to do with COVID-19.

Some Republican lawmakers contend it’s time for Gov. Cooper to end the COVID-19 emergency order - a step that would also lift the immunity provisions.

“That state of emergency is a cloud over North Carolina that is preventing the state from moving forward.” Sen. Burgin said.

But Jordan Monaghan, the governor’s press secretary, said the emergency order “provides a legal tool to make it easier for hospitals and other medical providers to provide health care and vaccines easily.”

The governor wants lawmakers to repeal or significantly modify a state law that has shielded nursing homes and other health care providers from legal liability related to actions and decisions related to Covid-19.

“The immunity provision is not a shield for wrongdoing and bad actors can and should be held accountable for their actions and resulting harm,” Monaghan said,

Some legislators across the aisle agree. Rep. Wayne Sasser, a Republican who co-chairs the House Health and Human Services appropriations committee, said he thinks it’s time for lawmakers to discuss repealing or amending it.

“Are we at the point where that needs to go away?” he asked. “ It definitely needs to be reconsidered.”

Said Sen. Joyce Krawiec, a Republican who co-chairs the committees on health care and health and human services appropriations, favors a partial step “The COVID immunity piece may need to be clarified so that it’s not so big and wide you can drive a truck through it,” she said.

Does NC need more inspectors?

The Observer reported that standard, in-depth inspections of North Carolina’s nursing homes dropped precipitously in 2020 and 2021 as inspectors focused their attention on infection prevention and control instead.

The state’s 96 nursing home inspectors conducted more than 2,000 infection control inspections in 2020 and 2021, said Richard, the DHHS deputy secretary.

Gov. Cooper’s proposed budget last year called for an increase in the number of inspectors. The General Assembly did not provide the funding.

Interviews with six legislators suggest lawmakers remain divided. Potts said he believes the state has enough inspectors. Burgin and Sen. Natalie Murdock, a Democrat from Durham who serves on the health and human services appropriations committee, contend the state needs more.

“With more oversight, you could catch those staffing issues,” Murdock said. “I support giving the department the resources they need.”

Despite disagreements on details, Murdock said she and her colleagues know they need to grapple with the staffing crisis inside nursing homes.

“The alarm bell has rung,” she said. “We have to do better. That’s what these families deserve.”

Staff Writer Joe Marusak contributed to this story.

©2022 The Charlotte Observer. Visit charlotteobserver.com. Distributed by Tribune Content Agency, LLC.