Colleen Diskin, The Record
Nursing homes in New Jersey can have as many — or as few — nurse’s aides on duty as they see fit, but some Democratic lawmakers are pushing for a new minimum-staffing mandate.
They have backed a bill that would require a minimum of one certified nursing assistant per every eight residents on the day shift, one for every 10 on the evening shift and one for every 16 on the overnight shift.
“Without a minimum standard, there really isn’t any way to make sure that some facilities aren’t trying to get away with as little staff as possible,” said Assemblyman Joseph Lagana, D-Paramus, one of the bill’s many sponsors.
The bill passed the state Senate on Dec. 17, after committee hearings in which lawmakers heard testimony from a number of nurse’s aides who told stories of having to rush patients through their meals and other daily rituals and of not being able to linger at the bedside of a patient who is dying and alone.
Nursing home operators largely testified against the bill, persuading sponsors to lessen what were originally more stringent staffing ratios but failing to get the Senate to consider a number of other amendments.
The Assembly’s last day of voting for the current session is Monday. If not passed then, sponsors would have re-introduce the measure after the new Legislature is seated and start the committee hearing process all over again.
Even as industry lobbyists contend that a majority of the state’s nursing homes already meet the staffing levels dictated in the proposed bill, they are trying to persuade lawmakers to delay action to have more time to consider what they call a much more complicated personnel equation.
The new staffing requirements could cost the industry as much as $67 million to hire as many as 2,000 new nurse’s aides — at a time when such workers are in short supply and managed care reforms could lower the government reimbursements that help pay their salaries, said Jonathan Dolan, president of the Health Care Association of New Jersey, an industry group.
Nursing home operators also argue the legislation would handcuff them in their hiring. Some facilities might need fewer nurse’s aides because they need more specially trained registered nurses for patients on ventilators, or more physical therapists for rehab cases, or more night-time activity coordinators for residents who are active after dinner.
“There really isn’t a one-size-fits-all approach that can be taken with staffing,” said Michelle Kent, chief executive officer of Leading Age New Jersey, a group that represents non-profit nursing home operators. “Every nursing home’s needs are different, and they need a lot of flexibility to decide from day to day and week to week on how to staff these facilities.”
Sponsors say the bill is in part a response to the poor scores received last year on a national AARP survey, which ranked New Jersey nursing homes 49th out of 50 states on preventing bedsores. The poor score, consumer complaints plus a number of worker accounts from members of 1199 SEIU, a branch of the Service Employees International Union, cemented the belief of the lawmakers sponsoring the legislation that the state had to strengthen staffing mandates, said Assemblywoman Valerie Vainieri Huttle, D-Englewood.
Geraldine Ballentine said that when she first began working the overnight shift at the Teaneck Nursing Center more than 30 years ago, there were six nurse’s aides on duty for the 100-plus patients. Now there are only four, which means that, between the hours of 11 p.m. and 7 a.m., she and her fellow aides are sometimes responsible for 26 or 27 patients each — and not all of them peacefully sleep through the night.
Ballentine said she must make hard choices all night long — whether to leave unattended the “sundowning” Alzheimer’s patient who might try to wander out of the building while she tends to someone getting sick in one room and also tries to hurry to the side of a fall-risk patient who needs to get to the bathroom.
“We have patients who don’t sleep at all,” said Ballentine. “You are with someone and then you have to leave to help somebody else, and by the time you get there, somebody might be lying on the floor. You don’t have time for any extras — to just sit with someone who wants someone with them.
Current law gives nursing homes a lot of leeway on the number and type of staff it hires, focusing instead on mandating a minimum amount of one-on-one care each patient must receive. A typical nursing home patient must receive at least 2.5 hours of individual care each day — a baseline that increases for patients with higher needs, such as those on dialysis or a ventilator.
Industry lobbyists point out that the New Jersey nursing homes typically exceed that per-hour-per-day minimum. A federal audit by the General Accounting Office last year found that New Jersey nursing homes on average provide each patient 4.4 hours of care each day.
Consumer groups and employee unions, however, have long complained that state regulators rely on nursing homes to self-report staffing data to the federal government. On that Nursing Home Compare website, only two of 32 nursing homes in Bergen County, and one of 20 in Passaic, scored below-average marks for their staffing levels.
A more accurate picture — one that factors in days and nights when scheduled workers call in sick and a last-minute replacement can’t be found — may emerge in July, industry observers say. That’s when a new provision of the Affordable Care Act will require nursing homes to submit payroll evidence when reporting staffing levels.