RI's nursing home staffing law was never enforced. Now its backers want broader changes.
Three years ago, the Raise the Bar on Resident Care coalition successfully lobbied the General Assembly to pass the strictest standards for nursing home staffing in the country. But that victory turned out to be hollow: The law was never enforced, and Gov. Dan McKee eventually chose to suspend it indefinitely.
Now, the same coalition is trying a different approach: Throwing its weight behind a pair of bills "designed to heal and improve our state’s broken nursing home system" by creating a new board that would set minimum pay and labor standards, and forcing nursing homes to be more transparent about their finances.
"With the industry having been given a free pass once more, it is clear we need a holistic approach that does more than enforce minimum staffing levels," Kathleen Gerard, director of Advocates for Better Care in Rhode Island, said in a statement. "We need a comprehensive solution that addresses the underlying reasons for the staffing shortage in the first place: low wages, inadequate training and lack of support."
What the bills would do
The Raise the Bar coalition, which is made up of labor unions, community organizations and advocacy groups, is backing two pieces of legislation this year.
The Rhode Island Nursing Home Workforce Standards Board Act, sponsored by Sen. Bridget Valverde, D-East Greenwich, and Rep. Scott Slater, D-Pawtucket:The act would establish a 13-member workforce-standards board for nursing homes, with three seats for the nursing home industry and three seats for nursing home workers or organizations that represent them. Two members would represent community organizations that work with Medicaid recipients and one would represent a joint labor-management nonprofit training fund. Seats would also be reserved for representatives of the Department of Health, Department of Labor and Training, Department of Health and Human Services and the Long-Term Care Ombudsman's Office. The board would have the power to set "minimum statewide compensation and working standards" for nursing home workers, states the House version of the bill, H 7733. (The Senate version of the bill hadn't been introduced as of press time.)Violations of those standards would be investigated by the Department of Labor and Training, and could lead to fines. Additionally, the board would set minimum standards for nursing home worker training programs.
The Nursing Home Financial Transparency Act, sponsored by Sen. Dawn Euer, D-Newport, and Rep. Matthew Dawson, D-East Providence:The bill, which hadn't been introduced as of press time, would require nursing homes to submit "annual, audited financial statements that include detailed income, expenses, and cash flow," according to a news release. They would also need to provide information about their ownership structures, which can be extremely difficult to find (and hard to understand.)"By making these reports publicly accessible, the bill seeks to end the era of financial manipulation that has diverted essential funds from resident care," the coalition says.
Failure to enforce staffing law prompts new strategy
The Nursing Home Staffing and Quality Care Act, which passed in 2021, led to immediate backlash. Citing an unprecedented labor shortage, industry lobbyists argued that nursing homes couldn't comply with the staffing requirements set out in the law, and that the resulting fees would put them out of business.
In response, McKee repeatedly delayed implementation of the law, and his administration failed to enforce it once it went into effect. Although no nursing homes have been fined, he issued an executive order in December that indefinitely suspended all penalties for potential violations. That order was renewed on Wednesday.
Union leaders have consistently argued that many for-profit nursing homes are raking in profits and facing a staffing shortage only because they refuse to increase wages for frontline workers. They see the proposed Financial Transparency Act as a way to prevent them from crying wolf and claiming to be in financial distress.
At a Thursday news conference, supporters recounted harrowing experiences inside understaffed nursing homes.
“When the pandemic hit, we went from a low-level crisis to a full-blown catastrophe," said Stefania Silvestri, a registered nurse who has worked in nursing homes for more than 20 years. "I would be putting one patient on oxygen and the patient in the next room is on the floor, but I just couldn’t get to them yet. The resident down the hall has a fever of 103 and they’re yelling out in desperation, ‘Help me, help me.’ They’re scared and delirious. There’s no one in sight.”
Jason Travers said that his father, who lived at a Johnston nursing home for four months before he died, once fell between the bed and the wall when he tried to get up to go to the bathroom without help. He lay there for 45 minutes before anyone noticed, Travers said.
“The only reason someone discovered it – it was the lunch crew that was coming to take his tray back,” he said.
This article originally appeared on The Providence Journal: Raise the Bar coalition seeks more oversight for RI nursing homes
