It took five years and a worldwide pandemic to make it happen, but state lawmakers Thursday approved a bill that would require a minimum number of frontline nursing home workers on every shift.
Certified nursing aides — who feed, bathe and comfort nursing home residents and get paid an average of about $36,000 a year — have long complained they have more responsibilities than they can handle, especially on nights and weekends. The coronavirus outbreak sickened thousands of these workers, making the shortage of CNA’s worse.
More than 7,100 nursing home residents and employees have died from the coronavirus. New Jersey has the highest per capita death rate in long-term care facilities in the nation.
If Gov. Phil Murphy signs the legislation, (S2712) into law, long-term care facilities will have to abide by these staffing ratios:
* One CNA per 8 patients during the day shift;
* One direct care staff member — defined as a certified nurse assistant, a licensed practical nurse or a registered nurse — for every 10 residents during the evening shift, “provided that no fewer than half of all staff members are to be certified nurse aides, and each staff member will sign in to work as a certified nurse aide and will perform certified nurse aide duties,” according to bill;
* One direct care staffer for every 14 residents during the overnight shift.
Labor unions and advocates for the elderly have fought for a version of a minimum staffing bill but nursing home operators have successfully argued the quotas would be too costly and hinder their ability to make staffing decisions based on patient need.
“New Jersey got an F rating and was ranked 43 out of 50 in direct care staffing hours per nursing home resident,” said Sen. Brian Stack (D-Hudson), one of the bill’s prime sponsors. “These are our parents and grandparents and soon, they will be us. We have to do better for the senior citizens of our state and ensure that they receive the care and attention we all deserve.”
The Senate approved the bill by a vote of 26-12; the Assembly passed it 56-21 with one abstention.
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Laurie Brewer, the Long-Term Care Ombudsman, has called the enactment of staffing minimums one of the most consequential changes the state could make to improve nursing home care.
“If properly implemented by the provider community and enforced by the New Jersey Department of Health, these new staffing ratios will reduce suffering and will result in a better quality of life for tens of thousands of New Jersey citizens who are living in long-term care communities today,” Brewer said.
The bill also establishes the Special Task Force on Direct Care Workforce Retention and Recruitment.
Setting minimum staffing standards is expected to have a financial impact on nursing home operators, which include the state’s three veterans homes and the nine nursing homes run by county governments. But a fiscal note by the nonpartisan Office of Legislative Services said there was not enough information to estimate the cost, which may be offset if the state raises its Medicaid reimbursement rates.
Other pandemic-related legislation intended to improve the safety of nursing homes also advanced Thursday. They are:
A4282, which requires long-term care facilities to maintain an adequate supply of masks, gowns, gloves and other personal protective equipment or face fines. The bill passed the Assembly 79-0; it awaits action by the Senate. Committees in both houses approved the legislation on Tuesday.
Nursing home operators with eight or more locations must stockpile enough PPE for 30 days and operators with fewer than eight sites must maintain a 60-day supply. Hospitals must maintain a 90-day supply, according to the bill.
A-4007, which requires the state Health Department to oversee the creation of an “isolation prevention project” in every long-term care facility within 30 days of the bill being signed into law. The bill passed the Senate 39-0 and the Assembly 79-0.
Residents must be allowed to “continue to engage in in-person contact and communication with other facility residents and family members, friends…during a public emergency, to the extent that such in-person contact remains consistent with the circumstances of the public emergency.” If in-person visits are temporarily restricted, the facilities must be ready to offer technology and staff to provide virtual visitation, according to the bill.
In August, Health Commissioner Judy Persichilli announced limited in-person visits may occur with family designated as “essential caregivers,” but numerous residents and family have said nursing home operators have not met the safety criteria to allow these visits to happen.
“For too many long-term care residents, it has been six months since they have seen the faces of those most dear to them. Social isolation is a serious health condition and has put our loved ones at risk,” AARP New Jersey State Director Stephanie Hunsinger said, thanking lawmakers for passing the bill.
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