Why arbitrary staffing mandates are not an indicator of quality

  • Unfunded staffing mandates are irresponsible during this Pandemic; national numbers disprove claims that staffing mandates correlate to quality care.
  • The 4.1 hour mandate would be the highest of all the states in the nation and is being put forward with zero dollars in funding.
  • Staffing mandates are arbitrary across the 50 states with twenty-five states having no mandate and twenty-five implementing mandates ranging from 1.9 to 3.6 hours. In New England, CT is at a 1.9 mandate while VT is at 3.0.
  • Massachusetts recently added a mandate into regulation after nine months of hearings and testimony from both sides. The compromise regulation is a 3.58 hour mandate accompanied by $90 million in funds.
  • According to the prestigious American Senior Rankings Report in 2019 RI was ranked 2nd in the country for quality care. Mandated staffing levels had little to no correlation with quality of care. States with lower or no mandates show up more frequently in the top 25 states for quality versus those with mandates.

Why unfunded staffing mandates will further cripple RI’s nursing homes

  • Deep and consistent cuts to Medicaid by the State since 2012, combined with the UHIP debacle, have left many homes already teetering on the edge.
  • Despite a 2012 law mandating Medicaid reimbursements be paid with an inflationary adjustment of approximately three percent a year, Medicaid has been cut each year since but two. In total, hundreds of millions have been cut (a dollar cut from State funding costs us another dollar from the Federal match) and the nursing homes have been operating on fumes to care for our most vulnerable residents.
  • To top all of this, the UHIP program which was supposed to make the healthcare system much easier for providers instead took millions from their operations. With payments for some Medicaid residents taking more than three years, and others being lost in the system, nursing homes have been left to care for residents with no funds to reimburse them.
  • Adding at least $75 million* in mandatory spending annually to a health care system already suffering economically is simply irresponsible.

*American Health Care Association Report January 2021

The Pandemic has created an unprecedented staffing crisis

  • As the State itself has found out in trying to staff the state’s field hospitals – there are no healthcare staff to hire. This has been the plight of the nursing homes for some time. The cuts in Medicaid reimbursement year after year, have kept wages far too low for nursing home workers and left hundreds of nursing home jobs vacant.
  • Despite constant requests to the state for assistance, Medicaid continued to be cut and workers went elsewhere for jobs during the more robust economic times. This left the nursing homes already searching for staff before the pandemic, and with the onset of the virus, still more workers have retired or stayed home for fear of the virus, or knowing they had a vulnerable family member at home.
  • This, on top of many staff testing positive and needing to be kept out of work for weeks at a time.

Dr. Alexander Scott herself has said implementing this policy is impossible

  • In a letter dated July 13, 2020, written about the mandatory staffing legislation, she stated:

“For minimum staffing standards to be successfully implemented,sufficient data must be available to establish meaningful metrics around minimum staffing, there must be a sustained pool of nursing staff (RNs, LPNs, CNAs) from which to hire, and appropriate financing must be made available to support them.”

  • This policy is being done with no industry input, an absolutely depleted certified work force and no funding. This is a policy that unfortunately has been designed to have nursing homes fail.