As employers in just about every service industry struggle to hire workers, nursing home operators in New Jersey are facing a special challenge of increased staffing requirements for nursing assistants under a law that took effect Feb. 1.
The new standard requires one certified nursing assistant for every eight residents during the day, with lower ratios for evening and night shifts. Increasing staff is seen as a clear way to improve care for patients. The New Jersey Department of Health has already cited eight facilities for not meeting the regulation.
“Nursing homes are making their best efforts to comply with the law,” said Andy Aronson, president of a trade group that represents nursing homes and other long-term care providers in New Jersey. “Many providers, despite their best efforts to hire CNAs, will not have enough CNAs to meet the statutory minimums.”
Previously, New Jersey did not have minimum staffing ratios for nursing assistants, who must be paid at least $15 an hour under a state mandate for the hard work of lifting, bathing, and dressing elderly patients. State officials did not provide a list of the cited facilities or say whether they were fined.
The new staffing requirements had been debated for years but weren’t passed until last year when nursing homes became the front lines during the pandemic.
Pennsylvania requires nursing homes to provide an average of at least 2.7 hours of nursing care each day for patients, but does not specify ratios for nursing assistants. Many experts consider Pennsylvania’s minimum too low.
Staffing challenges — long a problem but exacerbated by the current tight labor market — have added to the woes of the nursing home sector, which was hammered by high costs and lost revenue during the worst of the coronavirus pandemic.
Now, many nursing homes face an uncertain future as the number of families turning to nursing homes for loved ones remains down.
In New Jersey, only 66% of nursing home beds were occupied in May, down from 83% two years earlier, according to an Inquirer analysis of federal data.
The occupancy rate in Pennsylvania was 73% in May, compared with 87% in May of 2019.
Those numbers translate to a two-year decline of 21,000 nursing home residents in the two states.
Pennsylvania’s new budget contains $247 million for nursing homes from the state’s billions in federal American Rescue Plan aid to help compensate for higher expenses and revenue losses from lower patient counts. An additional $30 million is going to assisted-living facilities and personal-care homes. That nursing-home support works out to an average of $359,000 for each of the state’s 687 nursing homes.
“This was the critical lifeline that Pennsylvania operators needed,” said Zach Shamberg, president and chief executive of the Pennsylvania Health Care Association, a trade group for long-term care providers. “Lawmakers and the governor chose to prioritize long-term care, those who had been at the epicenter of the pandemic for nearly 16 months.”
SEIU Healthcare Pennsylvania, which represents at least 5,000 nursing assistants and others at nursing homes, is pushing operators to use that money to provide better pay and benefits for workers, the union said.
New Jersey nursing home companies, facing the same problems, received no such largesse from the state’s billions of American Rescue Plan money, said Sydney Greenberger, chief executive of AristaCare Health Services, a Cranford, N.J., company that operates six nursing homes in New Jersey and one in Pennsylvania.
Greenberger said one of his facilities had an annual licensing inspection last week and is possibly being cited for not meeting the minimum staffing ratio. State regulators have been telling nursing home managers that they need to show an effort to recruit and hire staff at the minimum staffing ratio, he said.
Inspectors allowed AristaCare to document its efforts, including advertisements and sign-on bonuses. The company even hired a recruiter. “We’re trying,” he said. “We want to be at the minimum staffing ratios. It’s hard to recruit.”
Signing bonuses are popular, but they are not the long-term answer, said Sharon Eyster, director of operations for the Wilmac Corp., a York, Pa., company with four nursing homes, including one at Attleboro Village, a retirement community in Langhorne.
Wilmac has seen workers job-hop for a $5,000 bonus, adding to workforce instability. Medicaid reimbursement, which pays for most nursing home stays, has to be higher, she said. The Pennsylvania average hourly wage for nursing assistants is $15, according to the Pennsylvania Health Care Association.
“We need to care for this population,” Eyster said. “It really is a community issue, a broader concern that I think the public needs to be aware of. We need to have people who truly have compassion and want to care for people who can’t care for themselves.”
Readers can look up staffing levels at homes by going to the federal nursing home compare site — https://www.medicare.gov/care-compare/ — and going to the ratings section for a home. Staffing has its own tab