A state senator wants more direct-care employees working in Kentucky’s nursing homes, which are among the lowest rated in the nation.
Senate Bill 206, filed by Sen. Tom Buford, would require the Kentucky Cabinet for Health and Family Services to develop a system of minimum staff-to-resident ratios for nursing homes as a condition of obtaining their state license, with different numbers for different units based on their residents’ health needs. Penalties would be imposed on facilities caught without enough staff on duty.
Federal law only requires that nursing homes have “sufficient” staff to meet residents’ needs, including a registered or licensed practical nurse on duty at all times. Some states set their own more rigorous standards, but Kentucky so far has not.
“It’s not rocket science,” Buford, R-Nicholasville, said Tuesday. “When you have elderly people in your care, you need to be checking on them regularly, and if you don’t have enough people on staff, you simply can’t do that.”
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Research shows that nursing home residents should get at least 4.1 hours daily of direct care, whether that comes from a nurse or a nurse’s aide, said Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington. However, most Kentucky facilities fall far short of that standard of care, Culp said.
“Residents in nursing homes are not things, they’re people,” Culp said. “You have to spend some time interacting with them and not just checking off a list of tasks to do. You have to know them to notice that they have had a slight change in condition and they’re going to need help now to avoid a worse problem down the road.”
Forty-three percent of Kentucky’s 284 nursing homes last year were rated as “below average” or “much below average” by the U.S. Centers for Medicare and Medicaid Services because of serious problems discovered with the quality of care they provide their roughly 12,500 residents, according to a Herald-Leader analysis of federal data. Chronic under-staffing was a frequent issue.
Buford said he and other legislators unsuccessfully pushed bills in past years that contained more specific ratios, such as one direct care employee for every six or seven residents. This time, he said, he deliberately referred the question instead to the cabinet, which can research what other states do and come back with its own set of regulations.
“I thought this time we’d be OK because we can trust the cabinet,” Buford said.
But Buford’s bill still faces long odds. The state’s nursing home industry is among Frankfort’s more powerful political donors and lobbyists. It traditionally has opposed tougher staffing standards, citing the cost of having to hire more employees at a time when facilities’ Medicaid reimbursement rates have been stagnant.
On Tuesday, Betsy Johnson, president of the Kentucky Association of Health Care Facilities, said she had not yet read Buford’s bill and so had no comment on it. Her group will be at the state Capitol on Thursday to meet with state Sen. Ralph Alvarado, who is chairman of the Senate Health and Welfare Committee — where Buford’s bill likely will be assigned — and Gov. Matt Bevin’s new running mate.
The Herald-Leader reported in October that Alvarado, a doctor, was also medical director at five substandard nursing homes while sponsoring bills the industry sought in the legislature. Alvarado did not return a call seeking comment Tuesday on Buford’s bill.
Given Alvarado’s past opposition to establishing staff-to-resident ratios at nursing homes, Buford said, he would prefer for his bill to go to another panel where it might get a warmer reception, such as the Senate Committee on Licensing, Occupations and Administrative Regulations.
“If we could get a hearing, I have a list of names of people who could speak on the bill,” Buford said. “I do not think there would be any shortage of Kentuckians who would want to share their stories about their bad experiences with their loved ones. I suspect we would pack the room pretty quickly.”
Culp, whose nonprofit agency visits nursing homes to monitor living conditions, said she worries that Buford’s bill would give the authority over staffing standards to regulators at the cabinet. Culp said she is asking for an amendment to the bill that would give ombudsmen and other resident-advocates a say in whatever staffing standards are established.
“I’ve been doing this for a while and I don’t recall any time when the cabinet has said, ‘Yay, staffing standards, this is something we’re really enthusiastic about and want to get behind!’” Culp said. “So I honestly don’t know what their attitude is going to be. I just worry that the process is left awfully open, the way it’s written now.”