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NURSING HOME REFORM NEWSLETTER

Feb. 14, 2005

THE FATE OF 208

Rep. Tom Burch had no sooner walked in the door of the health and welfare committee meeting room in Frankfort last week than he told someone that House Bill 208 – the bill that would have started quality staffing standards for nursing homes on its way through the General Assembly – might not be heard in his committee that day "because it costs too much." That rattled some people, not the least of whom was Rep. Kathy Stein (D-Lexington) who had worked hard to get the bill on the committee agenda. "Not much you can do," several legislators told us. "That’s why the chairman of a legislative committee is such a powerful position…. He can do anything he wants and we are mostly powerless to stop him," they said. Apparently the Louisville Democrat had second thoughts, however, and the bill was brought up and then the real shocker occurred. Rep. Burch announced that the bill would not be voted on in the committee because it would cost the nursing homes $20 to $30 million. Jaws dropped. Where on earth did the popular representative come up with that? After the hearing we were able to find out, sort of.

GO FIGURE.

Rep. Burch must have pulled the $20-$30 million cost figure out of thin air. All he would say for the record was that he got the figure "from the Cabinet" (for Health and Family Services). That is a little strange because we know this Cabinet and they do not throw figures around. They would have carefully calculated such a figure. To get how much it would cost for all the nursing homes in the state to comply with HB 208 would have taken weeks if not months of study and research. Someone would have to have found out what the staffing in nursing homes is now, and we doubt that information is readily available. And then they would have had to take the provisions of HB 208 and apply it to current staffing levels. Our bet is that someone in the cabinet said they would guess that complying with HB 208 would cost the nursing homes more money, and perhaps Rep. Burch took that - comment and got "help" from his nursing home friends in calculating a dollar number, the $20-$30 million number he used. Go figure.

SO WHAT?

So what if complying with HB 208 would cost more money anyway– even the $20-$30 million figure? The nursing homes would not have to get the money from the state because the state already has increased what they get in Medicaid reimbursements annually to some $55 million. They are now funded 100% of the so-called price-based formula. That is because on the last day of the 2004 session the nursing homes sneaked through an increase in the provider tax to the tune of a $110 million windfall for the state. Every dollar the nursing homes put in is matched about 3 to 1 by the feds. A good deal. The bad deal for nursing home residents was that little of the newfound money has been used to increase the numbers of front-line caregivers. This is what HB 208 would have done.

WHAT LEGISLATORS NEED TO KNOW.

When the price-based system for reimbursing nursing homes for Medicaid residents was put together a few years ago, the state hired a consulting firm to help them write the regulations for the new system. The consulting firm recommended that staffing ratios be included in the new price-based system. Not mandatory, but as a guideline to judge whether the nursing homes are providing quality care. Now that the nursing homes are fully funded as a result of the provider tax increase last year, they should be complying with the suggested staffing guidelines. What were the staffing guidelines that the consultants recommended? On front-line caregivers it is recommended that nursing homes have one front-line caregiver for every 8 residents on the first shift; for every10 on the second shift and for every 15 at night. And wouldn’t you know! HB 208 mandates 8, 12, and 18 and thereby lets the nursing homes off easier than the present state "model." Question: Is the office of inspector general’s nursing home inspectors enforcing the guideline. If not, why not?

902 KAR 20:026 SECTION 3, (9) (D) 2

This is a state regulation that tells the nursing home inspectors to enforce quality staffing for patients, a model for which is already in existence, too, and was just mentioned above. Here is what this regulation says: (d) Staffing classification requirements. 1. The facility shall have adequate personnel to meet the needs of the patients on a 24-hour basis. The number and classification of personnel required shall be based on the number of patients, and the amount and kind of personal care, nursing care, supervision, and program needed to meet the needs of the patients, as determined by medical orders and by services required by this administrative regulation. 2. If the staff to patient ratio does not meet the needs of patients, the Division for Licensing and Regulation shall determine and inform the administrator in writing how many additional personnel are to be added and of what job classification, and shall give the basis for this determination. But how are the state inspectors going to know whether the needs of patients are being met as regards to staffing? THAT’S WHERE THE CONSULTANT’S MODEL COMES IN. IT HAS THE GUIDELINES THE INSPECTORS SHOULD ENFORCE It appears to us that the power to mandate quality staffing ratios already exists, but is not being used. That’s why we badly needed HB 208.

WHAT’S GOING ON HERE?

The people in nursing homes are being hurt by the legislature’s failure to establish nursing home staffing standards for front-line caregivers. These are the nurses’ aides who are the front-line caregivers of residents day in and day out. It is easy to see why 37 other states have state regulations on nursing home care and Kentucky does not. The rich and powerful nursing home industry lobby in Kentucky has done a good job of confusing the issue in the minds of legislators. Perhaps Rep. Burch who is an able and veteran legislator has been caught up in their lobbying, too, which is surprising. He even said at the committee meeting, "Look, Bernie, I would sponsor your bill myself if it were not for this price tag." Even he believed what he was saying. Big mistake. Sorry mistake for people suffering in nursing homes.

WHAT’S IT GOING TO TAKE?

There is a growing realization in Kentucky and in the legislature that residents of nursing homes need help. We have yet to see this governor or his predecessors champion the cause, but we are very happy with the support nursing home reform in gaining in the legislature. Last week could have been an historic week for nursing home reform. No bills on staffing have been introduced in the General Assembly since the days of Rep. Gerta Bendl of Louisville and Rep. Louie Mack of Lexington who introduced such bills in the 1980s. Nursing home residents and their families should thank people like Kathy Stein, Bob Damron, Mary Lou Marzian (co-sponsors of HB 208) and many other current members of the House; and people like Sen. Tom Buford and Sen Ernesto Scorsone and others in the Senate, all of whom have stepped forward to support nursing home reform. We will put Rep. Tom Burch in that category, too. All he needs is better information.

QUOTE OF THE MONTH

"I hope our consciences bother us forever." -- Rep. Steve Nunn (R-Glasgow) railing at the General Assembly for spending so much of its time on taxation and budgets and ignoring important social issues like nursing home reform.

STAY IN TOUCH.

Don’t forget that Kentuckians For Nursing Home Reform now have a website which we try to keep up to date. You can stay in touch by watching the website which is www.KyNursingHomeReform.org

P.S.

John went to visit his 90-year-old grandfather in a very secluded, rural area of Georgia.

After spending a great evening chatting the night away, John's grandfather prepared a breakfast of bacon, eggs and toast.

However, John noticed a film like substance on his plate, and questioned his grandfather asking, "Are these plates clean?"

His grandfather replied, "They're as clean as cold water can get them. Just you go ahead and finish your meal sonny!"

For lunch the old man made hamburgers. Again, John was concerned about the plates as his appeared to have tiny specks around the edge that looked like dried egg and asked, "are you sure these plates are clean?"

Without looking up the old man said, "I told you before sonny, those dishes are as clean as cold water can get them. Now don't you fret, I don't want to hear another word about it!"

Later that afternoon, John was on his way to a nearby town and as he was leaving, his grandfather's dog started to growl, and wouldn't let him pass. John yelled and said, "Grandfather, your dog won't let me get to my car".

Without diverting his attention from the football game he was watching on TV, the old man shouted ... "COLDWATER, GO LAY DOWN!"

-- This one thanks to Bob Pfeifer of Louisville