State Standards/Regulations

CNAs try to mandate minimum staffing levels in Washington State

When reading one of my favorite sites for local updates, the Public News Service, I was reminded about the sad state of affairs for Washington caregivers in the nursing home industry. Washington doesn’t have a state law that spells out minimum staffing levels in nursing homes.  In the 2015 legislative session, nursing home caregivers will continue their battle to implement some basic staffing minimums.

Nursing home workers cite three reasons to mandate minimum staff-to-resident ratios: 1) Better care for nursing home residents, 2) Less turnover for weary staff members, and 3) Greater safety for both groups.

Shelly Hughes has been a Certified Nursing Assistant (CNA) in Washington facilities for five years. She explained that rarely is there enough time or enough staff in place to give residents the care they need. “One of the most heartbreaking things about my job is that I see great, kindhearted, hard-working people leaving,” she says. “Not only my facility, but the industry entirely because they’re so frustrated with the level of care we’re able to give our residents.”

Ms. Hughes says under current conditions, a CNA could be on duty for 15 or 20 residents.  Can you imagine? That ratio is not at all conducive to quality care for nursing home patients. However, Hughes points out that the facilities know in advance when state surveyors are coming to inspect. This is when managers pitch in and there are plenty of people scheduled.

AARP research indicates an annual turnover rate of 52% among nursing home workers in the state. Hughes says SEIU’s proposal would implement staffing rules over a three-year period, and nursing homes would submit monthly staffing reports with payroll records to the state, to confirm that they’re in compliance. She and other caregivers with SEIU Local 775 have been sharing their stories with Washington lawmakers, and she believes a new state law is a matter of time. “It will take a while, but I haven’t met a legislator yet that disagrees with anything I have to say,” says Hughes. “I think the will is there, we just have to find a way.” She adds, Oregon and California both have direct-care staff requirements for nursing homes. Washington caregivers will make their case at a lobby day in Olympia later this month, January 29. 

Who is “vulnerable” to nursing home abuse?

As I mentioned previously, nursing home abuse isn’t necessarily exclusive to those 65 years old and older.

In states such as Washington and Minnesota, “vulnerable adult” is used to refer to those who are alleged victims of nursing home abuse. Vulnerable adult is a broader category of individuals than the elderly and they are also frequent victims of nursing home abuse. The term is used in various states laws, including Washington and Minnesota. In Washington, “vulnerable adult” includes a person

a)     Sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself; or

b)     Found incapacitated under chapter 11.88 RCW; or

c)      Who has a developmental disability as defined under RCW 71A.10.020; or

d)     Admitted to any facility; or

e)     Receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW; or

f)       Receiving services from an individual provider; or

g)     Who self-directs his or her own care and receives services from a personal aide under chapter 74.39 RCW.

At the federal level, the Omnibus Reconciliation Act (OBRA) of 1987 was an important turning point in showing a serious commitment to ensuring better care for vulnerable adults. Included in the OBRA of 1987 was the Federal Nursing Home Reform Act (NHRA) with a Residents’ Bill of Rights. The goal of NHRA: To ensure that nursing home residents receive quality care that will result in their achieving/maintain their “highest practicable” physical, mental psychosocial well-being. While the NHRA was passed in 1987, the law did not truly become effective until the United States Department of Health and Human Services implemented regulations on September 26, 1991.

The NHRA specifies the services a nursing home must provide to its residents. The Act also lays out the standards for these services.  Among the required services: individualized comprehensive care plan, periodic assessments for each resident, nursing services, rehabilitation services, pharmaceutical services, dietary services. For nursing homes with more than 120 beds, a full-time social worker is required.

Over 90% of all nursing homes have Deficiencies

The vast majority of nursing homes in this country accept Medicare/Medicaid payment. When accepting reimbursement from the Center of Medicare and Medicaid Services (CMS), a nursing home is bound to CMS rules along with federal and relevant state regulations. According to federal regulations, a deficiency is a nursing home facility’s failure to meet participation requirements in the Act or in 42 CFR 483.

But guess what? A 2008 federal report that came out of the Department of Health and Human Services revealed that no less than 91% of 15,000 nursing homes that were included in the survey had seven deficiencies on average. Sadly, Washington State has one of the highest numbers for reported deficiencies in the country.  In 2010, a whopping 97.8% of Washington nursing homes were reported with deficiencies.  No wonder lawyers for nursing home abuse are sought after.

There are many reasons why the number is so high, despite the fact that  CMS and state health care agencies impose layers of rules and standards on nursing homes. One reason is that enforcement is difficult. The burden of enforcement is on the state. These days, most states cannot audit and investigate all the complaints. Even when a facility is found noncompliant, the penalties are relatively low and difficult to collect.  Only in the most egregious cases does does a nursing home get shut down.

This information and future posts that appear in this blog is intended to inform those who are concerned about the quality of care at a specific facility. Stay alert to signs of abuse because they are not always obvious. We will discuss much more about the different types of elder abuse.

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