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McKee signs bill setting highest staff-to-patient mandate in nation for RI nursing homes

Providence Journal - 5/27/2021

PROVIDENCE — Gov. Dan McKee on Thursday signed into law a nursing-home staffing mandate that loomed large over the 2020 elections amid an aggressive drive by the Services Employees International Union to oust any state lawmaker unwilling to commit.

While the nursing-home industry warned legislators the mandate would result in closures, advocates of the legislation said it would prevent residents from having to endure long waits for care and boost the wages of currently overstretched staff.

"Today we take a step forward for staff, residents and their families,'' McKee said during the signing ceremony outside the State House. "Stronger staffing standards and [more] funding for direct care staff will help raise the bar on resident care in our state."

"I am so excited to see this day finally come," said Adelina Ramos, a certified nursing assistant at the Genesis Healthcare nursing home in Greenville.

"More staff will be such a relief in our bodies, minds and spirits,'' she said. "It will allow us to focus on better care ... and by raising wages we will be able to attract more care-givers to the field who will know their work is valued and fairly compensated."

The new law will, effectively require an average of at least 3.58 hours of direct nursing care per resident, per day, starting on Jan. 1, 2022, and 3.81 hours starting on Jan. 1, 2023, which both sides agree is the highest staff-to-patient ratio in the nation.

As written, it will also require that 80% of any rate increase go directly to increases in "compensation and benefits" for staff who work at the nursing homes, many of whom are the dues-paying union members who work at the nursing homes. (It is not yet clear how much that will raise wages.)

Nursing homes are a huge and growing item in the state budget. The tab for Medicaid-covered nursing homes is a projected $410 million this year, and $418 million next year.

House Speaker K. Joseph Shekarchi presided over the negotiation of this year's compromise bill, which includes a dose of financial relief for the nursing homes.

The incremental increase in nursing-home reimbursement rates will, by October 2023, provide the industry with an additional $12 million or so a year.

Senate President Dominick Ruggerio said the nursing-home staffing bill has been a Senate priority since before the pandemic because of an awareness of what he called a staffing crisis.

"This bill ensures that our loved ones in nursing homes receive adequate care,'' Ruggerio said.

Nursing-home owners and their lobbyists warned of mass closings if the legislature adopted the staffing ratios called for by the new law.

The Rhode Island Health Care Association said the bill attempts to legislate "the impossible."

"It sets a staffing mandate that requires the hiring of over 800 new employees when our homes already cannot meet existing job demand,'' association president and CEO Scott Fraser said during the debate.

"The State of Rhode Island’s own website ... lists 1,877 openings in the same exact job classifications that are required by this bill."

But the lead sponsor of the Senate leadership's matching bill, Majority Whip Maryellen Goodwin, offered a different perspective.

“There is a resident-care crisis in our state,'' she said. "Staffing shortages and low wages lead to seniors and people with disabilities not receiving the care they desperately need."

The House sponsor, Rep. Scott Slater, said: "Sometimes when I hear this is a union bill, it will help some union members, right? But overall, it will help many more just regular employees that work on a regular basis in so many of our nursing homes."

The nursing-home owners denied accusations they have profited by deliberately understaffing their facilities. On the contrary, they argued, they are facing an existential threat from mounting losses and years of state cuts to Medicaid reimbursement.

Minimum staffing rules, they say, will only put more pressure on homes in danger of closing.

On Thursday, Fraser said: “Moving forward, the [Rhode Island Health Care Association] will continue to advocate for additional funding for our homes to try to meet this new mandate. Our concern remains that there just aren’t enough people available to fill the hundreds of new positions that will be needed.”

In 2020, then-House Speaker Nicholas Mattiello was targeted by the SEIU for defeat after he and several of his allies opted for a study of the potential ramifications of the minimum-staffing mandate.

Mattiello, facing headwinds from multiple directions, was defeated in his home-district last November.

This article originally appeared on The Providence Journal: McKee signs bill setting highest staff-to-patient mandate in nation for RI nursing homes

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