More than 72,000 skilled nursing home residents in Pennsylvania would see an increase in the hours of direct care they receive daily under proposed regulation changes, the first updates in more than 20 years.
Department of Health Acting Secretary Alison Beam announced last month that the changes would increase the minimum number of direct care hours for residents from 2.7 to 4.1 hours per day, which is more closely aligned with Medicare recommendations.
“Revising nursing home regulations is one piece of the administration’s ongoing effort to improve care for residents and working conditions for staff in nursing homes,” Beam said during a news conference in Harrisburg.
The announcement was held at Homeland Center, which Beam said is one of the 125 nursing homes in the state that already meet that proposed level of direct care. The facility provides 5.8 hours of direct care a day, according to the Centers for Medicare & Medicaid.
The rollout is the first of five packages of proposed changes to the state’s nursing home regulations, which were last revised in 1999. The proposals are based on the latest research, expert input and “informed lessons” learned during the COVID-19 pandemic, which disproportionately affected nursing home residents, state officials said.
More than 13,000 long-term care residents who tested positive for COVID-19 have died since the start of the pandemic, roughly half of the more than 27,000 deaths in the state. More than 72,000 long-term care residents have tested positive since the pandemic started.
“Lessons learned during the pandemic are being incorporated into the new regulations,” Beam said.
The first package of proposed regulations focuses on adding 1.4 required hours of direct care for residents each day.
Direct care hours can encompass a variety of services including hours with individual nursing staff including registered and licensed practical nurses and nursing assistance. Examples of hands-on care include medication, treatments, feeding, bathing, toileting and repositioning.
More than 100 national studies and reports have shown that the current minimum staffing requirement in the state falls short of meeting the needs for quality of care and quality of life.
Increasing the minimum direct care hours could greatly improve resident quality of care, Beam said. She cited studies that show 4.1 hours of direct care is the minimum level necessary to prevent infection, dehydration, fall injuries and malnutrition.
She added that many skilled nursing facilities already are providing at least three hours of direct care for each resident daily.
The first package also includes requirements for operators to comply with the Centers for Medicare & Medicaid Services regulations and requirements. This will make the state oversight process more efficient, create consistency and eliminate confusion in the application of standards.
Chief Long-Term Care Ombudsman Margaret Barajas said the state has an “ethical imperative” to make sure its most vulnerable residents are cared for.
“Just like you and me, they want to live in a home where they feel safe, and loved, and well cared for,” she said.
But when staffing hovers at the minimum requirements, residents suffer mentally, physically and emotionally, she said. Residents tell her and other ombudsmen that their caregivers are overworked.
“Residents, their loved ones and advocates have long raised concerns about the quality of care and ultimately, the quality of life that is afforded under existing care mandates,” Barajas said. “We are elated that our collective voice has been heard.”
Beam added the department understands these changes won’t just impact residents and staff but the industry, and it wants to partner with industry to see how it can increase viability.
But pushback from the long-term care industry started before the end of the press conference. In a press release, a state trade organization claimed the change will do nothing to improve the quality of care, and would directly impact staffing levels at a time when the state is facing a workforce shortage.
“The Department of Health’s newly proposed staffing requirement illustrates just how out-of-touch this regulatory agency is regarding the providers, workers and residents they oversee,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which represents 400 long-term care operators. “Today’s announcement, unfortunately, is a step in the wrong direction.”
In the current operating environment, the proposed increase in direct care hours is “unattainable, unfunded and unachievable,” and would cripple an essential component of long-term care in the state, Shamberg said.
To meet the 4.1-hour staffing standard, nursing homes will need to hire 7,000 more direct care workers, which could cost operators $6 million a week in new wages, Shamberg said.
“With no proposed new funding attached,” he added. “For an industry so dependent on a Medicaid reimbursement system that hasn’t kept pace with rising costs of care since 2014, this is simply unrealistic.”
There was no discussion at the press conference when the next set of proposals will be announced. Beam said the department wants to spread out the release of each proposed section of regulation changes so it will provide the opportunity for appropriate public comment.
The additional proposed regulation packages will involve change of ownership, staff development, staff ratios and infection control. Those packages will follow the same process for public comment.
The department has also submitted the first installment of proposed regulations to the General Assembly, the Independent Regulatory Review Commission and the Legislative Reference Bureau for review.
The Wolf administration wants to get the five packages of proposed regulations through the regulatory review process before the end of next year.
The department plans to submit final regulations once all five packages of updates move through the state’s regulatory review process.
After each public comment period is over, the Department of Health will review the comments and draft the final regulations, which will be sent to the Independent Regulatory Review Commission .
The commission will review the proposed regulations and ultimately decide whether the they will be implemented. The changes will apply only to the 692 licensed skilled nursing facilities in the state.
How you can comment on new nursing home regulations
Stakeholders, industry groups, resident advocates and the general public can comment on the Department of Health proposal to increase minimum daily hours of direct care to residents starting July 31.
Comments can be submitted to the Department of Health via email.