A solid level of nursing home staffing

If there were Olympic medals for the delivery of quality care in the state’s nursing homes, California would have just scored gold, silver and bronze in seven separate categories.

That’s how the federal government ranks the care that is currently delivered – 24 hours a day – to 350,000 residents in skilled nursing facilities in California.  Like many Olympic athletes, we’re at the top of our game, but always striving to do better.

It’s estimated that in the first year alone, the AB 2079 staffing requirement will cost $125 million.

Adequate staffing plays a role in this success.  Although the state requires a staffing level of 3.2 nursing hours per patient day, the average nursing home delivers 3.7 hours of nursing care to each patient, every day.  That’s an increase of 15 percent over what is required.

Assembly Bill (AB) 2079 would obligate nursing centers to go one step further and provide a minimum of 4.1 hours of care each day.  The federal government does not specify how many hours of care must be delivered daily, but it does require that nursing centers meet the individual needs of their patients.

That’s why most nursing homes staff according to need.  If a facility caters to residents who need short-term rehabilitation following a stroke or hip or knee replacement, there will be a greater number of RNs and other highly trained clinical staff.  For longer term care residents, who typically have less complex medical needs, daily care is typically delivered by certified nurse assistants (CNA’s).

A majority of residents in skilled nursing rely on Medi-Cal, the state’s free or low-cost health coverage for adults with limited income and resources, so any increase in staffing will result in higher costs for the state.  Since California just became one of the first in the nation to enact a $15 an hour minimum wage, the concept of a mandated staffing requirement just got a lot more expensive for taxpayers.  It’s estimated that in the first year alone, the AB 2079 staffing requirement will cost $125 million. However, by 2020, when fully implemented, state will be on the hook for more than a half billion dollars a year.

No one is against more staffing in healthcare settings.  What’s missing in this SEIU-sponsored bill is a thoughtful approach that takes into consideration the current skilled nursing workforce shortage, the scarcity of existing training programs and the lack of interest in this challenging field of work.

Hiring 10,000 more CNA’s will not necessarily lead to better patient outcomes.  The ability – and moreover the flexibility to invest in highly-trained licensed vocational nurses (LVN’s) and registered nurses (RN’s) will go a long way toward meeting individual patient needs – rather than an artificial staffing mandate.  There is a large body of research that shows conclusively that the presence of qualified, experienced RN’s is the number one factor that results in better patient outcomes.

The input of other important stakeholders is also a critical but missing ingredient in balancing the efficient use of general fund dollars while continuing to provide for the needs of the growing population of long-term care recipients.
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Ed’s Note:  Jim Gomez is the president and CEO of the California Association of Health Facilities.