Advocates for nursing home residents want legislators to mandate that facilities have more and better-trained staff.
Nursing home representatives say they would like to provide that, but they don’t have the money or the available workforce to do so.
Several members of the House Children and Seniors Committee expressed skepticism Tuesday about a bill that would increase staffing and training requirements at the state’s assisted living facilities.
Kansas Advocates for Better Care has pushed for the measures for several years, saying state averages fall well short of providing the almost 4.5 hours of daily care per resident that research shows should be the minimum to prevent resident harm.
But potential costs and the shortage of nurses and nurse’s aides to provide the care continue to give legislators pause.
Before the proponents of House Bill 2201 had finished testifying, Rep. Mike Kiegerl, a Republican from Olathe, already said he probably would vote against it.
“With this bill, I think we are asking something that cannot be done,” Kiegerl said.
The bill would require assisted living facilities to post staff-to-resident ratios for each wing and each shift, increase training requirements for staff and mandate that staffing ratios allow for a minimum of four hours and 26 minutes of care each day for each resident.
The current requirement is two hours. Rep. John Wilson, a Democrat from Lawrence who introduced the bill, said that’s insufficient.
“That requirement hasn’t changed since I was born — nearly 30 years ago — despite clear evidence that it may be an unsafe level of care,” he said.
Wilson acknowledged that assisted living facilities would have cost concerns, but said the quality care assessment fund, commonly referred to as a “bed tax,” is pulling in millions of federal dollars for the providers that could be used to improve patient care.
Long-term objectives
Cindy Luxem, president of the Kansas Health Care Association, which represents for-profit assisted living facilities, said her industry already is one of the most regulated and scrutinized.
She said the facilities she represents would like to have the resources to implement the additional hours of care requirement, but most are not in a financial position to do so and in some areas of the state the staff is just not available.
Luxem said a facility in Colby posted an ad for a certified nursing assistant that ran for a year with no qualified takers.
While her organization opposes the mandates in the bill, Luxem said the group agrees with the overall objectives to increase staffing and care.
“I would like to always have this as a discussion every year until we find enough money to make it happen,” Luxem said.
Rachel Monger, director of government affairs for LeadingAge Kansas, provided neutral testimony that outlined many of the same concerns.
“Steep funding barriers and workforce shortages make maintaining staffing rates a constant struggle,” she said. “Workforce challenges are particularly acute for our members in rural areas.”
Monger, whose organization represents nonprofit senior service groups, provided data from the Kansas Department of Labor that showed 545 open positions across the state for registered nurses and 726 open positions for nurse aides.
Managed care savings?
Mitzi McFatrich, executive director of Kansas Advocates for Better Care, said Gov. Sam Brownback’s technical education initiative had been successful in increasing the state’s nursing workforce, but she lamented the recent suspension of the program.
McFatrich’s group has pushed for HB 2201 and bills like it for several years.
A 2012 report from the Legislature’s internal auditors estimated that the cost to fully implement the staffing requirements would be $245 million, including $98 million from Medicaid.
But that was before the state placed all of its Medicaid services under the administration of three private managed care organizations, or MCOs. McFatrich said the state’s budget director had attached no fiscal note to the bill because the increased staffing costs would be absorbed by the MCOs.
She said the three companies actually would save money if they added staff because it would help prevent falls, bed sores and care errors that lead to costly hospital stays, as well as reduce the use of antipsychotic drugs.
“If the managed care companies are really doing their jobs, they’re going to have huge cost savings from this increase in staffing,” McFatrich said.
Facilities also would see long-term savings by preventing harmful events involving non-Medicaid residents, and those savings combined with the bed tax revenue would offset additional costs.
‘We understand and we do care’
Others joined McFatrich in advocating for the bill, telling stories of loved ones who they said endured preventable medical problems because of short-staffed facilities.
Kim High of Lawrence said employees at her mother’s assisted living facility failed to maintain her treatments for chronic obstructive pulmonary disease.
“I do not hold the facility responsible for her death; that was due to her illness,” High said. “However, I do find the facility responsible for hastening her death.”
Kiegerl said his heart went out to those who testified about the struggles of their loved ones. He suggested they contact a lawyer, and other committee members asked if they had reported the incidents to state agencies that oversee nursing homes.
Rep. Chuck Smith, a Republican from Pittsburg, choked up as he told High that at least half the committee probably had similar stories about their parents.
“No matter how we vote,” Smith said, “I want you to know, we understand and we do care.”
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.
