Nursing homes continue to be plagued by staffing issues resulting in resident care problems across the country. This time, we’re looking at California nursing homes that are fighting stricter staffing rules because, administrators say, it’s impossible to meet the tough, new guidelines.
While most states simply follow federal rules on nursing home staffing requirements, a few states choose to create their own guidelines on how many hours of care residents or patients should get in a day’s time, and California is one of those states. And now that nursing homes in California know what the new staffing guidelines are, over 50% of the nursing home facilities are asking to be exempted from the guidelines, much to the chagrin of the families of the patients in those homes.
Serious Staffing Issues
In California, the new law requires “facilities to provide 3.5 hours of direct patient care each day, up from 3.2 hours;” however, the main concern for nursing home operators is a first-ever requirement that 2.4 of those hours must be filled by CNAs (certified nursing assistants). The new rules took effect in July 2018 but are not yet being enforced.
While a CNA’s main responsibility is assisting patients with personal care, they also provide medical services such as taking vitals and helping treat pain. Nursing assistants are a crucial position in all nursing homes and assisted living communities, but the low pay, high stress, long hours, and physically demanding work often leave facilities understaffed. Recruitment and retention of CNA’s is a constant battle in this industry, and the high number of clinical and training hours required is another reason (often those hours are not offered “on the job” after being hired by a nursing home or assisted living facility).
Waivers Being Sought
Because of the tough new requirements, many nursing homes plan to seek waivers, which are allowed for by the law as long as a facility hasn’t been cited in the last three years for health and safety violations resulting in patient injury or death. In California, there are two waivers available: one for facilities that can’t meet the requirement due to a shortage in workforce and another for facilities that meet patients’ needs and reach the 3.5-hour ratio but not the 2.4-hour CNA requirement.
The deadline to seek a waiver with the Public Health Department was September 1, 2018, and those waivers are still being considered at the time of this writing.
The first waiver described above may be applied for only two consecutive years, while details of the CNA waiver are still being worked out.
Now that nursing homes are required to report actual payroll records to remain eligible for Medicare and Medicaid payments, state and federal agencies can more closely and accurately monitor staffing in nursing homes across the country. While families of the patients and residents in these homes are pleased that something is being done to provide better, more consistent care to their loved ones, nursing home owners and administrators are fighting the new staffing requirements and have realized they may need to reduce the number of beds in their homes or shut down altogether if their waivers are not granted and the staffing situation doesn’t improve.