The July 15 editorial, “Fixing nursing homes not as simple as mandating more staff,” is right to point out that ensuring quality care in New Jersey’s nursing homes is a complex issue. But it is wrong to argue that pending legislation (A382/S1612) to establish standards for nursing aide staffing levels is far from a solution.
Certified nursing assistants (CNAs) are the foundation of quality care in nursing homes. Their role is vital to meeting patients’ most fundamental daily needs — feeding, dressing, bathing and providing emotional support and comfort during difficult times. They play a distinct role as the primary caregivers in nursing facilities, despite typically earning just $11 to $13 an hour.
It is inconceivable, even in the best of circumstances, for a CNA to be expected to provide care at an adequate level if they are responsible for a dozen or more patients at once. Yet without clear and straightforward staffing requirements, nursing homes are often dangerously understaffed, and patients and their families often don’t know how their nursing home is stacking up.
In fact, an explosive story by Kaiser Health News, published on the front page of the New York Times earlier this month, exposed how nursing home operators for years overstated staffing levels to government regulators. In this largely for-profit industry, financed by billions of taxpayer Medicaid and Medicare dollars, this is a gross breach of the public trust and a wakeup call for New Jersey legislators to bring real accountability and transparency to nursing homes.
Ranked nationally, New Jersey nursing homes are among the worst of the worst when it comes to CNA staffing hours per patient — falling behind 43 other states. New Jersey also ranks unfavorably on quality care indicators such as the percent of high-risk long stay residents diagnosed with bed sores, a serious health problem that studies have found to be strongly associated with inadequate staffing.
After so many years of lax oversight, the industry is fiercely opposed to legislation that would enact minimum CNA-to-patent ratios. Nursing home lobbyists are now spinning a misleading claim of a shortage of CNAs in New Jersey — a concern that the industry has never brought up until now, a claim brought without evidence and which contradicts the daily experiences of CNAs.
Indeed, the nursing home industry has done quite the opposite of working vigorously to recruit and retain more skilled caregivers in the face of a purported shortage. Instead of making an effort to ensure that CNAs feel invested in, are listened to, and able to support their families as they take care of ours, many employers are in fact seeking to lay off workers and cut wages, benefits, staffing levels and other job standards that keep workers motivated to stay in their profession. As a result, turnover rates in this industry are exceedingly high as workers move from facility to facility, looking for adequate compensation and safer working conditions, but there is no evidence of an overall shortage.
Nor is it true that establishing minimum ratios is a rigid “one size fits all” approach, as industry lobbyists repeat ad nauseam. Ratios simply set a minimal floor, while allowing for facilities to staff above that level to ensure proper care for especially vulnerable populations. Staffing ratios are used appropriately and successfully in a number of settings where a few staff are responsible for safeguarding a large number of people — from flight attendants on airlines to teachers in daycare centers. Surely a similar framework is appropriate for protecting the safety and well being of the communities’ most vulnerable.
Indeed, Centers for Medicare & Medicaid Services, the federal body which oversees nursing homes, has recognized that “states have found that requirements for increased staffing levels resulted in improved resident care outcomes and decreased deficiencies.” Several states have adopted CNA-specific ratio laws in nursing homes, and the sky has not fallen. On the contrary, it has resulted in better, more person-centered care.
It is long past time for New Jersey to establish a ratio law so that nursing homes are held to basic safe staffing requirements. With the support of South Jersey legislators including Senate President Steve Sweeney, Sen. Nilsa Cruz-Perez, Sen. Troy Singleton, Sen. Jeff Van Drew and Sen. Chris Brown, the Senate has passed the bill and now the Assembly needs to act. After so many years of the industry masking staffing levels through dishonest reporting, we must protect patients and bring a real level of compassionate care to nursing homes.
Milly Silva, of Montclair, Essex County, is executive vice president of 1199SEIU United Healthcare Workers East, part of the Service Employees International Union.