Dec 19, 2018
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What is “Safe Staffing”?

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Understaffing is a common problem in many nursing homes. Residents in these facilities often must wait long periods to be taken to the bathroom, have their diapers changed, to be turned and repositioned to prevent pressure injuries, for call bell response, or receive assistance in being fed.  The Buffalo News recently did an analysis of staffing in nursing homes in N.Y., and discussed new legislation.

Known as “Safe Staffing,” the legislation has the support of the elder advocates, staffing experts, and nursing home employees.  The proposed bill would require nursing homes and hospitals to maintain specific minimum staffing ratios for nurses and certified nursing assistants. At present, these facilities are required only to have “sufficient” staffing levels based on the needs of the residents.

Under the bill, each nursing home’s registered nurses, licensed practical nurses and certified nursing assistants would have to spend a total of 291 minutes a day with each resident, on average or 4.51 hours per patient day (HPPD).  The minimum safe staffing is 4.1 HPPD according to previous studies. The national average is 234 minutes or 3.9 HPPD

Only 49 of the 619 nursing homes in New York State — or 8 percent — now meet the proposed law’s ratio, according to data from the federal Centers for Medicare and Medicaid Services.

Minimum staffing ratios are necessary to ensure quality health care in the region’s nursing homes because many of them have been sold to for-profit companies, said Assemblywoman Crystal D. Peoples-Stokes, D-Buffalo, a co-sponsor of the bill.

“Your bottom line becomes more important. You do things to keep your budget in order and that might not always be in the best interest of residents,” said Peoples-Stokes, who said she believes there will be increased attention to the bill in 2019. “I think it is a conflicted model to say you can have a for-profit business that delivers quality care for the people who are least able to do for themselves.”

State Sen. Timothy M. Kennedy, D-Buffalo, a co-sponsor of the bill, says minimum staffing ratios are necessary to improve the quality of care for residents and working conditions for nurses and CNAs.

I worked as an occupational therapist in nursing homes and the things I have seen with my own eyes I hope never happen again,” said Kennedy, who took aim at for-profit nursing home operators. “They cut back on staff and ultimately the care residents are getting to boost up their bottom line. The bad actors need to be called out and I think this legislation will do that.”

Helen Schaub, an official with Local 1199 of the SEIU, which represents 40,000 nursing home workers in the state, said union members face unrealistic workloads and are frustrated that they cannot provide the quality care they know residents require.

“We fundamentally believe that there is a staffing problem in nursing homes where the bulk of work is done by certified nursing assistants. If you are one person and you are trying to take care of 20 residents and responding to urgent needs, helping people go to the bathroom, then you don’t have time to turn people,” Schaub said, referring to guidelines for repositioning residents every two hours to prevent pressure sores.

In 2004, California required nurse staffing ratios for hospitals and nursing homes. In July, it increased the amount of time certified nursing assistants are required to spend with nursing home residents. Under the revisions, CNAs must provide 144 minutes of the total 210 minutes that the nursing staff  is required provide to each resident daily.

The Centers for Medicare and Medicaid started requiring nursing homes to report staffing levels based on payroll records. Last week, the centers announced it had begun sharing the payroll information with states when potential low staffing issues are spotted. States, in turn, will be required to investigate.

In general, the new payroll-based staffing data shows most facilities have somewhat fewer staff on weekends, but some facilities have significantly lower weekend staffing,” the Centers for Medicare and Medicaid said in a statement.

Michelle Spencer, who worked in Buffalo area nursing homes for 25 years as a social worker, said she decided to leave nursing home work four years ago because she could no longer take working in a high-pressure system that she considers broken. She now works for a company as a geriatric care manager that sometimes takes her back into nursing homes.

As an outsider, she said, “I see that it is still a failing and broken system,” especially when it comes to staffing levels.

And that is why Spencer thinks the state requirement of sufficient staffing levels needs to change to minimum staffing ratios.

“Adequate staffing is in the eyes of the beholder,” she said. “It’s subjective.”



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Advocacy · Staffing · Trial themes

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