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Plan for more staffing in Pa. nursing homes draws industry criticism in Harrisburg

One senator wondered how homes could even find more workers required by the health department's plan while another senator called the request for delay disgraceful.

Acting Sec. of Health Alison Beam is the point person for new nursing home regulations that have generated strong resistance from industry. 
 She is shown here in April in Hershey.
Acting Sec. of Health Alison Beam is the point person for new nursing home regulations that have generated strong resistance from industry. She is shown here in April in Hershey.Read moreCommonwealth Media Services

Pennsylvania nursing home leaders told a Senate panel Wednesday that it would be impossible to meet the increased staffing levels proposed for the state’s nearly 700 nursing homes and that more discussion was needed to solve the state’s nursing-home staffing woes.

The plan “should go back to stakeholders, the experts on the front lines who can tell you, who can tell state government what is best moving forward,” said Zach Shamberg, chief executive of the Pennsylvania Health Care Association, a long-term care trade group. He delivered his comments at the joint Senate hearing in Harrisburg before the Aging & Youth and Health & Human Services Committees.

The only pushback for Shamberg and other industry representatives came from State Sen. Maria Collett, minority chair of the Aging & Youth Committee and a Democrat representing parts of Montgomery and Bucks Counties. She said calls for delaying the proposed regulations, which would increase the state’s minimum level of direct care to 4.1 hours daily per patient, up from the current 2.7 hours, were disgraceful.

When Matt Yarnell, president of SEIU Healthcare PA and former nursing assistant in a nursing home, suggested toward the end of the hearing that this is not the time to “slow down, put the conversation in a 24-month process,” he drew a sharp response from State Sen. Michele Brooks, a northwestern Pennsylvania Republican who chairs the Health and Human Services Committee and whose party controls the legislature.

“I don’t think anyone has said slow down,” Brooks said. “I think what we have said is that we need to figure out some of these moving parts, so there’s not unintended consequences.” Brooks said she worries about nursing homes closing because they can’t get staff, forcing elderly individuals who need that level of care to live “two or three hours away from their family instead of in a local community.”

Earlier in the hearing, Brooks said she was concerned that the regulations were putting the “cart before the horse,” given the estimated need for 7,700 more nursing home workers to meet the higher minimum.

“Do we need to be working on workforce development, wages, increased funding, and build up to those 7,000 new workers?” Brooks asked.

Industry representatives like Shamberg’s group and LeadingAge PA were part of a long-term care work group convened by the Department of Health under Democratic Gov. Tom Wolf that met regularly during 2018 to discuss the first revision of the state’s nursing-home regulations since the late 1990s. That group did not include representatives of advocacy organizations.

Shamberg and Adam Marles, president of LeadingAge, which represents nonprofit long-term care providers, complained that the group hadn’t met since 2018 and that the discussion needed to be restarted.

The effort to revise Pennsylvania’s nursing home regulations followed a 2016 report by Auditor General Eugene DePasquale that criticized the Health Department for not being consistent when evaluating compliance with staffing requirements and other problems.

The effort is coming to a head during the COVID-19 pandemic in which over 13,000 people have died in Pennsylvania’s nursing homes.

It’s not clear what it would mean for the regulatory process that has already started if the long-term care working group resumed its meetings. The Health Department submitted the staffing regulations, the first of five sets of nursing home regulations, to the Independent Regulatory Review Commission in July.

While elected officials in Harrisburg sit on the sidelines during the regulatory review, the leverage they have is money. The state would have to come up with $173 million a year ― its share of extra Medicaid funding — to pay for extra staff. An additional $190 million would come from the federal government.

The commission received 5,500 comments on the proposal, according to acting Secretary of Health Alison Beam. The commission’s comments on the proposal are due Sept. 29. After that, the department will consider all the comments and possibly make revisions.

Linda Burns, who lives near Scranton, provided one of the comments, about the care her husband received this year at nursing home in that Northeast Pennsylvania city. On her husband’s floor, she said, there were two staff members, a licensed practical nurse and a nursing assistant, caring for 65 patients on the evening shift.

“It’s a miracle he’s alive,” she said.