Panel to vote on new direct care rule at nursing homes
Residents of nursing homes could receive at least 46 minutes per day of direct care from registered nurses
A group chants outside the Center Home for Hispanic Elderly on Thursday (William DeShazer, Chicago Tribune / March 1, 2012)
Advocates of nursing home reform view approval of the rule as a critical step toward improving the quality of nursing homes in Illinois, as studies have found that care provided by registered nurses, the most highly skilled workers in nursing homes, is closely tied to higher quality of care.
Current state law requires only that nursing homes have one registered nurse on duty for eight hours each day. The most recent available data show that 17 percent of Illinois nursing homes, or about one in six, have reduced the amount of registered nursing care they provide to the average patient by at least 10 percent since July.
An analysis by Hoy and the Tribune found that nursing homes across the United States that earned a three-star overall rating from Medicare's Nursing Home Compare provided an average of 43.3 minutes of daily registered nursing care per resident.
Nursing home owners are divided on the proposed rule. Pat Comstock, executive director of the Health Care Council of Illinois, which represents nursing homes, said the group supports increasing staffing levels to ensure quality of care to residents but opposes the rule as an across-the-board mandate on patient care.
"We believe that RN care time should be determined by only one factor: the residents' health care needs as outlined in his or her health plan," she said. "In this rule, the same percentage applies across the board and treats the residents of every facility in the state as if they are the same. We are saying that one size does not fit all."
Following an investigation by the Tribune, the legislature in 2010 passed sweeping nursing home reforms that included an increase in the amount of daily staffing required for residents who need skilled care. On Jan. 1 the amount increased from 2 hours, 42 minutes to three hours, and in the next two years it will rise again to 3 hours, 48 minutes.
But the law did not specify minimum levels for registered nursing care, which advocates are seeking to change.
"I wouldn't be surprised if some homes might be staffing more heavily with (certified nursing assistants) in the absence of definition," said David Vinkler, associate state director of advocacy and outreach for AARP's Illinois legislative office. "That's why it makes sense to do all of this. You have to be comprehensive about how you address staffing in nursing homes."
Some legislators, including state Sen. Jacqueline Collins, D-Chicago, also see the proposed rule as a way to reduce glaring staffing and quality disparities between facilities where the majority of residents are black and those in which most of the residents are white.
"All the senior citizens of our state, regardless of race, income or geography, should be able to count on a reasonable level of care when they enter a nursing home," Collins said last week. "It's a disservice to our seniors when disparity exists, especially if it is race-based."
Illinois leads the nation in the number of poorly rated majority black nursing homes. Just more than half, or 26 of 50, majority black nursing homes have received a one-star quality rating from Nursing Home Compare. Facilities with one star are considered to have "quality much below average." In contrast, 110 out of 640 of majority white nursing homes, or 17 percent, received that rating.
Comstock said racial disparities could be better addressed by raising Medicaid rates because majority black facilities have higher percentages of Medicaid recipients. If the rule is passed, it will cost $122 million annually in registered nurse wages and benefits for Illinois nursing homes, she said.
Some nursing home owners, however, support the proposed requirements.
"We feel that the 20 percent RN staffing ratio could clearly benefit quality resident outcomes," said Kirk Riva, vice president of public policy for Life Services Network, which represents more than 500 long-term care providers, including not-for-profit nursing homes. "The vast majority of our members are already meeting or exceeding that."
Emily Byrd, chairman of Jane Addams Senior Caucus, said the rule would take the landmark nursing home reform legislation passed in 2010 to the next step.
"Without rules for implementation, the legislation has done little if not nothing to improve conditions in nursing homes," she said. "It is time to put the law into effect."
Last week, 70 nursing home workers and others held a protest in front of the Center Home for Hispanic Elderly in Humboldt Park, a facility where 98 percent of residents are Latino and where regulators are investigating complaints of understaffing and supply shortages.
An analysis by Hoy and the Tribune found that the nursing home provided residents about 20 minutes per day of registered nursing care in February, down more than 60 percent from July. The figure puts the facility among the lowest 7 percent nationwide for nursing care. An attorney for the home said last week that staffing and supplies are adequate.
Deborah L. Shelton is a Tribune reporter, and Jeff Kelly Lowenstein is database and investigative editor for Hoy.