In July 2018, new staffing requirements were quietly passed for California nursing homes as a part of the states yearly budget bill. The new rules require nursing facilities to provide at least 3.5 hours of direct care per resident per day, an increase from the previous 3.2 hours.
The goal is for nursing home staff to give more direct care to their patients, to include tasks like inserting a feeding tube or helping residents with eating and bathing.
Nursing home staff have been unsupportive of the new requirements, claiming that it doesn’t meet current facility needs and residents remain at risk in poorly staffed homes, according to the LA Times. Conversely, nursing home officials say it is unaffordable to hire the amount of staff necessary to meet the requirement.
It’s tough to find qualified nurses and assistants in California’s robust economy, and reimbursement from Medicare and Medicaid are inadequate, home officials tell the LA Times. They have also criticized a provision of the new requirements that 2.4 of the 3.5 hours of patient care must be provided by a certified nursing assistant, rather than another nursing professional.
The new hours of care have not yet been implemented, with more than half of California’s nursing homes are asking for exemption from new state regulations. The California Department of Public Health, which approves or denies the request of exemption, is expected to announce in late January which — if any — facilities are not liable to the new regulations.
Some of the California facilities seeking exemptions have been repeatedly cited by the state’s Department of Public Health for inadequate staffing that led to patient harm.
Matt Robinson, legislative affairs director for the California Association of Health Facilities, an industry group, told the LA Times that nursing homes are asking for flexibility because of the variety of individual needs and diagnosis of each patient. It’s important for facilities to find quality staff to ensure a sustainable workforce to meet the mandate. Otherwise, it’s an empty mandate, according to Robinson.
Robinson said facilities are applying for exemption waivers on a “good-faith basis.” If waiver requests aren’t granted, he said, nursing homes may reduce the number of their beds or even shut down.
During the first three months of 2018, 58% of California’s skilled nursing facilities averaged at least 3.5 hours of patient care a day, according to a recent Kaiser Health News analysis of payroll records submitted to the federal government. That rose to 76% in nursing homes where administrators also were counted.
The same analysis found that for years nursing homes nationwide overstated staffing to the federal government. Now, nursing homes are required to report actual payroll records to remain eligible for Medicare and Medicaid payments.
California is one of only a few states that set minimum requirements for nursing home staffing. Most states abide by federal government standards requiring skilled nursing facilities that receive money from Medicare or Medicaid to have enough staff to meet residents’ needs.