Nursing homes oppose proposed staffing mandates

SALISBURY — A sweeping bill pending before Connecticut lawmakers that would impose mandatory minimum staffing hours at nursing homes is being met with opposition by operators of Northwest Corner facilities,which are still in the throes of a pandemic-induced nursing shortage.

S.B. No. 989, which has been introduced by the Human Services Committee of the Connecticut General Assembly, would boost the direct-care hourly time that a nurse or CNA spends with a resident from 3 to 4.1 hours per person each day. Facilities that fail to comply could face civil penalties.

While the proposed measure is well-intended, said nursing home operators in Sharon, North Canaan and Salisbury, the reality in the rural Northwest Corner — and across the state — is that nursing homes are already short staffed.

Solutions, not staffing reforms and sanctions, are what is critically needed, they said.

Pandemic pummeled staffing levels

“The nursing home workforce is at its lowest level since 1994,” said Christine McKinney, regional director of operations for Athena Health Care Systems, which operates Sharon Health Care Center.

In a Feb. 16 letter to members of the Human Services and Aging Committee expressing Athena Health Care Systems’ opposition to the proposed bill, McKinney pointed to “worrisome findings” from a January 2023 job report from the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL), which analyzed data collected by the U.S. Bureau of Labor Statistics between January 2020 and December 2022.

“The report notes that skilled nursing staffing levels won’t return to pre-pandemic levels until 2027,” she said, adding that nursing homes lost more employees than any other business in the health care sector, a total of 210,000 during the report’s timeframe.

“Our frontline workers are continuing to feel the pressure. We are continuously working on preventing staff burnout in what’s clearly a difficult hiring climate,” she explained. “If the industry job climate doesn’t improve — all signs show that it won’t — this measure has the potential to do more damage than good as the staff is just not there.”

McKinney warned lawmakers that, “If you force this action this will stress the skilled nursing sector in the state causing closures for all facility owners.”

Currently, Sharon Health Care Center is “continuously looking at our staffing levels to ensure we have the appropriate staff in place to care for existing residents and safely accept more patients into our centers,” according to Athena spokesperson Savannah Ragali.

“Across all of our centers if we do not have the appropriate staffing levels, we will pause new admissions until we are safely able to care for the residents.”

A temporary solution at Noble Horizons

The Noble Horizons Senior Community in Salisbury recently reduced capacity at its nursing facility from 91 to 65 beds in order to maintain staffing ratios at about the proposed 4.1 hours per patient, according to Administrator Bill Pond.

“Otherwise, we would not have been able to provide the type of care we are recognized for,” he said.

“We identified this as our solution. We were able to find staffing and operate at numbers we are very comfortable with.”

The fix, though, is only temporary, noted Pond.

“For us to reopen the 30-bed unit we would need to hire 18 to 22 people, most of them nursing staff, and that’s just not plausible in the current environment.

“I don’t think there’s anybody who doesn’t want to see better staffing levels, but the proposed regulations come at a time when we are trying to find ways to find staff for the levels we are used to operating at.”

Geer CEO:

two-pronged problem

In a Feb. 1 letter to State Sen. Richard Blumenthal, Kevin O’Connell, CEO of the Geer Village Community in North Canaan expressed concerns with the Biden Administration’s plan to issue a regulation through the Centers for Medicare and Medicaid Services (CMS) that would impose a nationwide minimum staffing mandate.

“We applaud any effort to help increase staff for our state’s nursing homes,” wrote O’Connell in the letter, which he also directed to CMS administrator Chiquita Brooks-LaSure. “Nursing homes everywhere are already doing everything they can to recruit and retain staff. Unfortunately, a staffing mandate simply will not work for Connecticut for two main reasons.”

The first, he said, “is that the workers are simply not there.”

The staffing mandate that the administration is considering would require an additional 181,000 nurses nationwide, O’Connell explained. “These nurses don’t exist.”

The second reason a staffing mandate will not work is even if the additional 181,000 nurses were available, wrote O’Connell, nursing homes do not have adequate funding to pay.

“A study from the accounting and consulting firm Clifton Larson Allen determined that the cost of the Biden Administration’s staffing policy would be more than $11 billion in the first year. CMS has no ability to pay for these positions and it seems unlikely that congress will do so.”

Every administration, including the Obama administration, has rejected this staffing proposal because it is “impossible to operationalize without a major influx of workers and funding.”

The Geer administrator said in a telephone interview on Feb. 16 that he has the same message for Connecticut lawmakers and is opposed to Bill No. 989.

Struggle with staffing

On Feb. 16 H.B. 989 was discussed at a joint hearing of the commissions on Human Services and Aging which drew dozens of nursing home staff, administrators and residents to Hartford.

Among attendees was Jim Thompson, administrator of the Torrington Center for Nursing and Rehabilitation, who expressed opposition to the proposal.

“We struggle every day with staffing,” and underfunding, Thompson said in his testimony. He noted that some days the facility operates with between 10 and 12 open positions. Often, he said, temporary hires choose not to show up because they are offered higher pay at other facilities.

“I think we have to keep in mind what is attainable. Our residents do deserve extra staffing but I don’t see it happening at this time,” said Thompson. “There’s no other way to say it. You can’t get blood from a stone.”