Boosting direct care hours at nursing homes would cost $24M
Shahrzad Rasekh / CT Mirror
John Bodnar, a resident at Advanced Center for Nursing & Rehabilitation, reads the news in his room every day.
Legislators intent on boosting direct care for nursing home residents have recommended raising the daily minimum staffing requirement from three to 3.6 hours, a change that would provide about 36 minutes of additional care per resident each day.
But a recent analysis by the state’s nonpartisan Office of Fiscal Analysis shows the move would come with a hefty price tag: $24.2 million, half of which would be picked up by the state through Medicaid payments.
“It’s going to be very difficult to pass this year,” said Sen. Jan Hochadel, D-Meriden, co-chair of the Aging Committee. “Unfortunately … we cannot afford [it] at this time.”
Hochadel said she continues to advocate for the measure, which her committee voted to advance in March, but “We have a rocky road.”
“This is something we have wanted to do, to increase staffing to take care of our elderly, but in this fiscal climate we have to make some hard choices,” Aging Committee Co-Chair Jane Garibay, D-Windsor, added.
Legislators are grappling with unprecedented challenges to state finances.
More than $500 million in emergency federal pandemic grants that are being used to fund ongoing programs will be unavailable going forward. A series of budget caps that have generated huge surpluses since 2017 have gradually weakened health care and other core programs and must be scaled back, Democratic legislative leaders say.
State officials’ largest concern, though, involves large anticipated reductions in federal aid in the coming months.
Under the staffing bill, nursing homes would be required to provide a minimum of 3.6 hours of direct care for each resident every day. They currently must provide three hours, though some homes already staff at higher levels.
Direct care is defined as hands-on care from a registered nurse, nurse’s aide or licensed practical nurse that includes feeding, dressing and bathing.
The measure also would impose new penalties for violations. Facilities that fail to comply with the increased staffing requirements could face fines of up to $10,000 per violation. The bill also gives the state health commissioner the authority to suspend a nursing home’s license or certificate or issue citations for lapses.
Nursing home industry leaders oppose the plan.
Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, said the cost is a challenge, as is recruiting staff.
“We have a reimbursement system where costs drive the rates. If you mandate increased costs to the facilities, those have to be reimbursed under the Medicaid program,” he said. “While that’s a challenge in any environment when there’s staffing shortages, it’s especially challenging to come up with the dollars to do it in the current fiscal climate.”
Earlier this year, he testified on the bill: “Because of the ongoing staffing shortages in the sector, nursing homes will inevitably need to unsatisfactorily rely, in increasing frequency, on temporary nursing staffing agencies in an attempt to comply with these highly prescriptive standards.”
Mag Morelli, president of LeadingAge Connecticut, which represents nonprofit nursing homes and adult care providers, said she supports strong staffing but worries about the expense.
“Right now, everyone is very concerned about how much they’re spending and potential cuts to the Medicaid program from the federal side,” she said. “There’s a shortage of workforce, so as one sector needs to increase staffing, it raises the cost of all staffing. There is a limited amount of people to go around in the health care sector.”
House Speaker Matthew Ritter, D-Hartford, said the lack of clarity around federal Medicaid funding makes it difficult to back numerous proposals, including nursing home staffing increases.
“One of the most disappointing things as a state right now, for me, is the uncertainty at the federal level is impacting a lot of our Medicaid decisions,” he said. “Whether it’s an Aging Committee bill or the Medicaid caucus priority bill, we do need to wait for more information from Washington.”
Congress is trying to achieve savings in Medicaid and other programs worth $880 billion over 10 years to help pay for President Donald Trump’s proposed federal tax cuts.
Connecticut expects to spend $11.6 billion this fiscal year on Medicaid. About $4.7 billion of that is the state’s cost, with the other $6.9 billion covered by federal reimbursement.
But state officials fear that if Congress hits all or most of its cost-cutting target, Connecticut will lose hundreds of millions of dollars in annual support at best, billions at worst.
Along with the federal funding uncertainty, lawmakers also are confronting expired labor contracts for nursing facilities’ staff.
More than 6,000 nursing home employees spread among more than 60 facilities statewide are working with expired contracts. And another 3,500 health care workers, most assisting clients with disabilities in group homes, are due for wage hikes.
Though no specific work stoppage date has been announced, SEIU District 1199 New England — the state’s largest health care workers union — has said it wants legislators to expand Medicaid funding to support raises before the regular General Assembly session ends June 4.
“We also have a nursing home contract issue going on, so we have to balance all of the different bills relative to the industry,” said Sen. Cathy Osten, D-Sprague, co-chair of the Appropriations Committee.
“We’ve got to get our arms around the nursing home industry and direct care. We’ve had [several] nursing homes close in the last 12 months. As we continue to move through this process, we have to remember that we want to still have nursing homes, and we’re going to have to grapple with the needs the industry has.”
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