The Pennsylvania Department of Health on Wednesday announced sweeping reforms meant to improve care provided to nursing home residents, months after a global pandemic focused attention on the shortcomings of the state’s existing regulations.
The state’s proposed regulatory change would increase the required time spent providing direct care for each nursing home resident to 4.1 hours from 2.7 hours within a 24-hour period. Acting Secretary of Health Alison Beam, who led a briefing on Wednesday, said the change is part of a package of reforms that she anticipates going into effect after 2022.
An industry group quickly responded that the new mandate would be unattainable and increase costs for already-strapped facility operators. Meeting the standard would require 7,000 new nursing home workers — “who at this moment do not exist” — and cost nursing home operators $6 million per week. according to the Harrisburg-based Pennsylvania Health Care Association.
But the plan was welcomed by SEIU Healthcare Pennsylvania, a union representing some 45,000 nurses and other health care workers, which called the Wolf administration’s proposal “long overdue.”
Conditions in the state’s nursing homes came under a spotlight over the past year or more after the highly contagious COVID-19 swept through facilities, causing illnesses and deaths.
In November, a Post-Gazette investigation found that cuts to full-time staff and reliance on temporary staffing agencies at Brighton Rehabilitation and Wellness Center in Beaver County hindered its response to a devastating COVID-19 outbreak at the facility, which killed more than 80 residents.
Although the facility faced scrutiny from regulators and state and federal investigations, the Post-Gazette reported that it was among thousands of facilities nationwide that received incentive payments from the federal government despite deadly outbreaks.
Pennsylvania’s rule change would affect the state's 692 skilled nursing facilities. Personal and assisted care homes are governed separately by the state Department of Human Services.
"Revising nursing home regulations is one piece of the administration's ongoing effort to improve care for residents and working conditions for staff in nursing homes," Ms. Beam said.
"Residents, their loved ones, and advocates have long raised concerns about the quality of care and ultimately, the quality of life that is afforded under existing care mandates," state Long-Term Care Ombudsman Margaret Barajas said in a statement. "We will continue to advocate for adequate staffing levels and care to not only reduce or eliminate the consequences of inadequate staffing that often result in harm or even untimely death."
More than 72,000 people live in Pennsylvania's nursing homes.
With Wednesday’s announcement, the Department of Health submitted the first installment of the new rule to the General Assembly, Independent Regulatory Review Commission and Legislative Reference Bureau. A 30-day comment period and public hearings will follow.
The changes were based on research, input from experts and industry stakeholders, the department said.
More than 13,000 residents of long-term care facilities died from COVID-19 in Pennsylvania, according to state figures.
Although most of those deaths occurred in nursing homes, over 1,800 personal care and assisted living residents died. The Post-Gazette reported on the surge of cases in these facilities, which have less government oversight than nursing homes.
The proposed regulations do not make changes to personal care homes, which are overseen by the Department of Human Services.
The debate over whether increasing the minimum number of direct care hours by 1.4 hours per resident each day will improve nursing home patients’ experience is likely to continue.
The Pennsylvania Health Care Association called the state’s plan “out of touch.”
“Once again, the experiences of long-term providers were disregarded,” the association said in a statement. “Rather than include input from the front lines of the pandemic, Department of Health officials chose to draft regulations with unachievable mandates that will do nothing to improve the quality of care in Pennsylvania.”
LeadingAge PA, a Mechanicsburg, Pa.-based senior care advocacy group, said it continued to support the minimum threshold of 2.7 hours of care per day, considering the health department has the authority to require additional staff, if it’s necessary.
But, “Now is not the time to increase the staffing threshold” in light of emerging technological advances and other innovations, the group said.
Other parties saw it differently.
“We applaud the Wolf administration for taking this bold step and making Pennsylvania a leader for long-term care transformation,” SEIU Healthcare President Matthew Yarnell said in a prepared statement. If passed, Pennsylvania would become the first state to adopt the new care standard.
SEIU Healthcare is negotiating contracts at 80 nursing homes in the state, including ones in Beaver, Fayette and Westmoreland counties.
Medicaid, the state-federal health insurance program for the needy, is the biggest payer for skilled care, and acting Human Services Secretary Meg Snead said the new direct care standard would increase skilled care costs by $366 million annually, with the federal government covering $193.2 million and the state picking up $173.6 million in Medicaid reimbursement.
Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699
First Published: July 21, 2021, 6:37 p.m.
