R.I. House approves minimum staffing standards for nursing homes

The bill, which now heads to the State Senate, will also secure funding to raise wages for direct caregivers

In April 2020, Rhode Island resident Carol Pouliot hoped to be able able to visit her and hug mother, Gloria, 87, in person again. Wearing surgical gloves, she cradles her phone with a photo of her hugging her mom in her room at a Worcester nursing home.John Tlumacki/Globe Staff

PROVIDENCE — After the pandemic exposed the stark realities of short-staffing at nursing homes, Rhode Island House of Representatives overwhelmingly approved legislation Tuesday that will set minimum staffing standards and quality care for the first time.

The bill, sponsored by Providence Democrat Scott A. Slater, will also secure funding to raise wages for direct caregivers and to recruit and retain a stable and qualified workforce. The bill now heads to the Senate, where Senate Majority Whip Maryellen Goodwin of Providence is a sponsor.

This legislation was personal for Slater, whose mother, Josephine, died at a Providence nursing home last May. As her health failed, Slater saw how his mother’s care changed from one home to another, depending on what they could afford. He saw the impact of short-staffing on otherwise dedicated nurses and attendants, who struggled to take care of frail residents.

He said that experience was why he wanted to level the field, so all residents receive quality care, and why he sought to invest in training and raise the wages of staff.

“It’s terrible when your loved one has to go into a facility, and there are winners and losers,” Slater said.

The nursing home industry lobbied mightily against this legislation, and also against a similar bill sponsored by Senator Maryellen Goodwin that was approved in the Senate in February. Nursing home administrators argued that they couldn’t find enough help and they couldn’t afford to raise wages, because they have been underfunded by Medicaid for years.

People who had loved ones in nursing homes, unions for nurses and attendants, and several legislators fought back, testifying about what they saw when their loved ones moved into nursing homes.

When the pandemic surged, an ongoing staff shortage became a crisis that hit everywhere. More than 95 percent of all nursing homes and assisted living facilities in Rhode Island have had confirmed cases of COVID-19. According to the state department of health, 84 long-term care and 50 assisted living facilities reported COVID-19 infections in Rhode Island; of those, only five nursing homes and 15 assisted living facilities didn’t have any residents die.

Even now, nearly a third of nursing homes in Rhode Island have reported staffing shortages in the last four weeks ending March 21, according to the most recent analysis by AARP of data from the Centers for Medicare and Medicaid Services Nursing Home COVID-19 Public File.

The bills by Slater and Goodwin, called the Nursing Home Staffing and Quality Care Act, address the shortages by mandating that residents will be guaranteed a basic standard of care. The legislation establishes a minimum standard of 3.58 hours of resident care per day by Jan. 1 and 3.81 hours by Jan. 1, 2023.

The legislation will also invest in needed training and skills enhancement for caregivers to provide care for patients with increasing acuity and complex health care needs.

Earlier Tuesday afternoon, Governor Dan McKee said he was concerned about creating an “unfunded mandate” with staffing requirements. “I was pretty vocal about it last summer ... if we are going to increase staffing through mandates, especially in a pandemic, that there is some financial relief included,” he told reporters during a news conference at the State House.

Many Rhode Island nursing homes received money from the CARES Act to help pay for increased COVID-19 testing, staffing, and personal protective equipment, and quality incentive payments for those with a lower rate of COVID-19 infections and deaths.

Berkshire Place in Providence, where nearly all of its 220 residents were infected with COVID-19, received more than $612,000, among the largest amounts going to a nursing home in Rhode Island.

Administrator Lindsey Bouchard said the federal money “made a big difference” last year. As the infection spread, so did the demand for PPE, and prices skyrocketed, she said. Staffing agencies also boosted their rates as the pandemic worsened, with some even doubling the cost, Bouchard said.

The federal money helped Berkshire Place increase the pay rates for the staff, so they could retain them, Bouchard said.

They needed the infusion of federal money. The staffing bill passed by the House and Senate is another matter.

Bouchard, who has testified against the legislation several times, said the problem is the lack of reimbursement from Medicaid. “The government does not fund nursing homes, and they make it hard with this bill,” she said. “We’ll have to hire more CNAs, and there are so many on unemployment and not going back to work.”

But lawmakers were adamant about the need for the bill.

House Speaker K. Joseph Shekarchi said it was one of the most important bills he wanted to tackle during this session. And Deputy Majority Leader Jason P. Knight said that if he could, he would vote for it twice.

“Don’t think about this bill as a Draconian restriction delivered to the nursing home industry,” said Knight as he urged members to vote for the bill. “This is a worker protection bill. It gets at a practice of worker exploitation in this industry. ... We are telling the nursing home industry there is a floor beyond which you cannot go. You can use your homes as a loss leader, but you can’t do it at the cost of patient care.”