(Source: MIRS.news, Published 05/04/23) A likely incoming federal staffing mandate for nursing facilities could unfairly penalize facilities struggling to fill positions after the COVID-19 pandemic, Richie Farran, vice president of government services with the Healthcare Association of Michigan, told a House committee today.
Farran, who testified before the House Health Policy Committee, said current estimates put Michigan at a 10,000 employee loss within nursing facilities since the onset of the pandemic, making up about 17% of Michigan’s long-term care workforce.
He said providers across the approximately 360 nursing facilities statewide have done everything possible to fill open positions and retain workers, including increased wages, stronger benefits and more flexible schedules.
Currently, federal law requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed services, with a registered professional nurse used at least eight hours a day, seven days a week, according to the federal Centers for Medicare and Medicaid Services.
But with the federal government looking at strengthening requirements, Farran said a likely staffing ratio mandate proposed by the federal government “could not come at a worse time.”
“We all want to increase staffing at nursing facilities,” he said, “but an unfunded mandate and orders for people who are not there to be hired only reduces access to care. The fragility of the sector cannot be overstated.”
Rep. Jamie Thompson (R-Brownstown), a former nurse in long-term care facilities, said no one wants a bandaid fix on nurse-to-patient ratios. However, she said the patient load on nurses who are expected to fill the gaps results in burnout and a decrease in quality patient care.
She asked if Farran believes there is a safe nurse-to-patient ratio.
Farran responded that everyone wants more staff, and quality staff equals quality care. He said the association isn’t opposed to increasing staff in nursing facilities.
However, he said their opposition stems from the mandate and the penalties that could result from failing to meet mandated staff ratios, at a time when the pool of qualified employees just isn’t there.
Instead, he requested the legislature focus on assisting the industry with policy aimed at attracting and retaining long-term care workers, including the creation of a career ladder for frontline caregivers and initiatives to improve the reputation of workers.
He said one bill the association is looking at advocating for is a statewide medication registry process for CNA’s, which would allow them to pass an examination and administer more medications.
Nurses say close to 90% of their shift can be spent administering medication, he said.
Farran said there is a process for registering in 22 other states right now, and the bill is something they’re hoping to see in 2023.
Another policy the association has been working on is increasing the presence of CNA recruitment in high schools, similar to program promotion seen among skilled trades.
But for nurses already in the field, Farran said Michigan’s regulation of facilities is another factor that can lead to employee burnout in some cases.
Michigan's regulatory environment is “one of the most robust in the nation,” he said, with both more severe citations and higher indicators of quality care than seen in other states.
He said that during the pandemic, the combination of staff burnout and “robust” examinations in facilities led to staff feeling the job was “thankless, and we lost a lot from the profession from burnout, a little bit from the regulatory oversight.”
He said that keeping the balance with proper regulations has been an ongoing concern that could be addressed with more guidelines for timely inspections and getting back into compliance after a violation.
However, Farran said things are improving in terms of relations with the Department of Licensing and Regulatory Affairs (LARA) and the creation of a new bureau to assist with timeliness and professionalism of inspections.
“I think we do have a good line of communication with LARA,” he said, “and I think we've seen improvements.”
