My view

Build Back Better needs essential staffing standards

By Richard Mollott
Posted 1/5/22

A sufficiently staffed nursing home fosters an environment where residents can attain and maintain their highest practicable physical, emotional and psychosocial well-being. All too often, however, …

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My view

Build Back Better needs essential staffing standards

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A sufficiently staffed nursing home fosters an environment where residents can attain and maintain their highest practicable physical, emotional and psychosocial well-being. All too often, however, nursing homes fail to provide the necessary levels of skilled nursing care, supervision, and 24-hour services as required by federal law. As a result, the most vulnerable Americans suffer every day from neglect and substandard care. We are all paying the price.

The Build Back Better Act is a golden opportunity to address pervasive understaffing in long-term care. Unfortunately, a once-promising bill has been stripped of the essential staffing standards—federal minimum staffing standards and 24-hour Registered Nurse (RN) coverage—that could have led to real change. The bill’s authors say they want to overhaul the long-term care system but failing to address the fundamental nursing home problem—understaffing—is endorsing the status quo and abandoning the 1.1 million individuals in U.S. nursing homes whom we promised to protect.

The Long Term Care Community Coalition (LTCCC) is calling on Senate leaders, especially Senate Majority Leader Chuck Schumer (NY) and Senate Finance Chair Ron Wyden (OR), to reinstall the following two vital provisions:

  1. The implementation of federal minimum staffing ratios. Safe staffing is the most important predictor of a facility’s quality and safety. Although some states have enacted minimum standards, establishing minimum ratios at the federal level is crucial to protecting residents nationwide. So long as providers are not mandated to meet basic safe-staffing requirements, understaffing will remain a pervasive problem.
  2. The requirement for 24-hour RN coverage. Nursing homes with higher registered-nurse staffing had fewer COVID-19 infections and better quality outcomes. RNs are specifically trained in infection-control planning and management, resident assessment and care planning, and the identification and treatment of chronic and acute conditions. That’s why the provision in the Build Back Better Act that every nursing home provides, at a minimum, one RN in the building 24 hours a day is so important. Good facilities are already providing 24-hour RN nursing. Though industry lobbyists are claiming that 24-hour RNs are too expensive, LTCCC research indicates that 24-hour RN staffing is possible at a fraction of the price that industry lobbyists claim.

Our residents are worth the investment.

The pandemic was a wake-up call to the nation that nursing homes must be held accountable for following through on the promises they make to residents and families. The Build Back Better Act can help to ensure that promises made are promises kept. It passed in the House of Representatives in November. Now it is time for every U.S. Senator to stand up for the seniors and families in their states and demand that the important staffing provisions are put back in the act.

Want to take action? Contact your senators and let them know that nursing home residents need essential staffing standards in the Build Back Better Act. [As of this writing, although the bill had failed in the Senate, observers generally agree that it still has a chance.]

Richard Mollott is the executive director of the Long Term Care Community Coalition.

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