What to know about reaction to McKee pausing law setting minimum staffing at nursing homes

When a law designed to give Rhode Island nursing homes the highest patient-to-staff ratio in the country went into effect at the start of the year, it was like a weight was lifted off workers' shoulders, according to Adelina Ramos.

"We were finally able to care for our patients properly and give them the care that they deserve," said Ramos, a CNA at Genesis HealthCare's Greenville Center who fought for years to get the law passed.

Then, last week, Gov. Dan McKee issued an executive order that gives nursing homes a temporary break from those requirements. To Ramos, "it feels like we went back instead of going forward."

Nursing-home workers are "burned out," she said, and feel "like they have to leave because they’re not being appreciated."

Executive Order:McKee gives nursing homes a break from minimum-staffing law

Trade groups representing most of the state's nursing homes had asked McKee to delay implementation of the law, saying that about 1,920 positions were already vacant statewide, and that they'd have to hire about 475 other workers on top of that to comply with the requirements.

But the groups that pushed for the law say that the delay is unnecessary — and that the staffing crisis can only be solved by paying better wages.

Spokespeople for McKee did not immediately respond to a request for comment.

"I think the governor is listening to the wrong people," said Patrick Quinn, the executive vice president for District 1199 SEIU New England. "He should meet with the front-line staff — they’ll tell him what’s going on."

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Shirley Lomba, a CNA/CMT at the Bannister Center in Providence, is one of those front-line workers. She works in an Alzheimer's unit, where being short-staffed can be particularly challenging.

"Some of the residents don’t have any family, and you build a bond with that person," she said. "If today's a good day, you want to spend a little more time with them. But you don’t have time to sit and talk to them because you have 10 other people you need to get done."

Advocates' solution: Raise wages, improve conditions

The Raise the Bar coalition, a group of unions and nonprofits that pushed to get the law passed, sent a letter to McKee on Wednesday and asked him to rescind the executive order.

"Delaying implementation of this law in the middle of our generation’s worst public health crisis is exactly the wrong direction for our state’s most vulnerable citizens," the letter states. "The only way to end the nursing home staffing crisis is to improve wages and working conditions and make nursing homes safer for staff and residents."

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Among the coalition's objections: The executive order claws back staffing requirements that were in place even before the new law went into effect, reducing the amount of time when a registered nurse must be present from 24 hours a day to 16 hours a day. (Licensed practical nurses will fill in when there's no RN on duty, but can't perform certain tasks.)

Law includes wiggle room

Additionally, Quinn said, the new law already gave the health department "broad authority" to waive or reduce fines when unforeseen circumstances arise, provided that nursing homes make a good-faith effort to meet the staffing minimums.

For instance, if a nursing home ended up short-staffed because someone who'd been scheduled to work was exposed to COVID and had to call out at the last minute, the DOH could waive the fines. (Nursing homes can use that call-out provision only twice a year, however, according to the law.)

Broadly speaking, "if nobody met the standard, then no one would be in trouble," Quinn said.

And while there's no doubt that nursing homes are dealing with a staffing shortage, the number of people receiving care in those facilities has actually dropped as a result of the pandemic, Quinn said.

The premise that there's "a backlog of people in hospitals" waiting to get into nursing homes is incorrect, he said. (Industry groups previously said that about 71% of Rhode Island nursing homes were limiting admissions due to staffing shortages.)

RI provided money to cope

Another thing that's been overlooked, Quinn said, is that the General Assembly granted additional funding to nursing homes so they could staff up before the law went into effect.

One pot of money is coming from a cost-of-living-adjustment increase, 80% of which is supposed to go toward wages or staffing.

Quinn said that some union nursing homes have already used that funding to increase worker pay, but he's not sure how many facilities statewide have done so. (Most of the state's nursing homes are not unionized.)

Additional funding was supposed to come from a .5% rate increase that has to go through the federal Center for Medicaid Services, but nursing homes haven't received that money yet.

But that .5% rate increase will cover only $2 million of the $21.3 million that will cost for nursing homes to get into compliance, according to the Rhode Island Health Care Association.

Earlier pushback on law: Nursing homes call for one year delay in new minimum staffing requirements

Industry group sees 'unfunded mandate'

The association, which represents 64 nursing homes in the state, says that the staffing law amounts to an "unfunded mandate."

The problem, Gage said, is that Medicaid has "serially slashed reimbursement" to Rhode Island nursing homes, which are underfunded by $50 million a year, by the group's estimation.

Many facilities are already paying overtime and bonuses to supplement their existing staffing levels, president and CEO John Gage wrote in an a letter to McKee. They're also turning to temporary staffing agencies, "often at rates that amount to price gouging."

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Lomba said that it's become increasingly common for people to leave full-time jobs at nursing homes in order to work for staffing agencies, where they bounce around from facility to facility and collect much larger paychecks.

Where she works, salaries typically start at $15 an hour, she said. As a travel nurse, she could be earning $21 to $25 an hour.

"I've seen it as high as $27 an hour," Lomba said. She's been in her job for 18 years, and likes the stability and the benefits. And she feels that Alzheimer's patients "need to see the same faces day after day."

But she can understand the temptation to leave.

"It just boggles my mind that nursing homes would prefer to pay an agency, when you can pay your own staff," she said.

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Other industries that are dealing with their own staffing shortages, including the service industry, have raised wages to attract workers. That means that some nursing home workers may consider leaving for another field entirely.

"Do you want to deal with blood and s--- and people dying, or do you want to serve coffee and make the same money?" Quinn asked.

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COVID by the numbers

Cases in R.I.: 339,571 (1,912 reported Thursday)

Negative tests in R.I.: 6,807,305 (16,486 reported Thursday; 10.4% positive rate)

R.I. COVID-related deaths: 3,288 (13 reported Thursday)

Rhode Islanders hospitalized with COVID: 441 (46 in intensive care)

Fully vaccinated in R.I.: 801,239 (923,548 at least partially vaccinated)

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Cases in Mass.: 1,580,605

Mass. COVID-related deaths: 21,752

Cases in U.S.: 72,991,867

U.S. COVID-related deaths: 876,747

This article originally appeared on The Providence Journal: SEIU, Raise the Bar criticize McKee order on nursing home staffing