Lawmakers Want to Improve Ratio of Aides to Patients in NJ Nursing Homes

Legislators say they want to advance care and safety, but facility operators express misgivings about the measure

nursing home
New Jersey nursing homes would be required to hire scores of additional certified aides to help residents bathe, dress and get around, under legislation designed to improve care and safety for some of the state’s most vulnerable seniors and institutionalized residents.

The Assembly Human Services Committee approved a bill to establish specific staff-to-patient ratios yesterday over the cheers of certified nursing aides, the front-line workers who provide much of the daily nonmedical care for nursing home residents, and other healthcare advocates.

The proposal sets minimum requirements for day, evening and night shifts that supporters said are in line with the laws in other states, and would address a longtime priority for the state’s healthcare workforce; nurses are also advocating for an update in decades-old regulations for nursing ratios in hospitals.

But the nursing home legislation, which would not regulate staffing levels for registered nurses or other workers, raised concerns for some facility operators and business groups. There is already a shortage of certified nursing assistants, or CNAs, and the bill would trigger the need for an additional 3,000 aides at a cost of some $95 million a year, according to research by the New Jersey Hospital Association, which represents more than 100 nursing homes. Several operators said that, without funding to help cover these costs, the bill was essentially incomplete.

Christie vetoed similar measure

The state Legislature approved a similar measure two years ago, only to have it vetoed by former Republican Gov. Chris Christie in early 2016. Supporters of staffing ratios have re-started the campaign under the administration of Democratic Gov. Phil Murphy, who took office in January; that has included holding a robust rally in front of the State House on May 1 led by 1199SEIU, a union that represents some 8,000 nursing home workers in New Jersey.

Milly Silva, the union’s executive vice president, told committee members the Garden State now ranks 44th nationwide when it comes to the current staff-to-patient ratios, and the situation has only grown “more urgent” since Christie vetoed the previous bill. “These statistics are alarming and should serve as a wakeup call,” she said.

“Inadequate staffing is a major underlying factor of poor patient care in nursing homes,” said Assemblywoman Angelica Jimenez (D-Bergen) the lead sponsor of the bill.

With some 1.3 million seniors in New Jersey and the large baby-boomer population aging, experts agree there is a critical need for quality nursing home care, despite a growing focus on helping elderly individuals live out their days safely at home. The state now has some 370 licensed nursing homes and has taken steps recently to improve care at these facilities, including “Peggy’s Law”, which Christie signed in August to require nursing home staff to call 911 if they suspect elderly abuse.

The NJ Long-Term Care Ombudsman — formerly called the Office of the Ombudsman for the Institutionalized Elderly — a federally mandated office that dates back to 1977, also serves as a voice for these residents. The office trains several hundred volunteers who work directly in nursing home facilities to support their senior residents.

Quality, not quantity

Under current law, New Jersey nursing homes must provide a certain amount of care for each resident, currently set at 4.1 hours per day. Specialized units have other staffing regulations as well. The legislation (A-382) would instead require a set ratio of one CNA per eight residents during the day; one per ten during the evening; and one per 16 for overnight shifts. Homes could hire even more, if they chose.

Nursing home operators told the Assembly committee that the quality of the care they provide consistently ranks highly nationwide and many facilities already employ more CNAs than would be needed under the legislation. “It’s the quality (of caregivers), not the quantity that matters,” said James McCracken, who led the state ombudsman’s office for eight years under Christie and now represents nonprofit nursing homes for LeadingAge New Jersey, an advocacy organization.

But Evelyn Liebman, associate state director of AARP New Jersey, said Garden State nursing homes compare poorly when it comes to preventing pressure sores — a common result of limited attention — or reducing hospitalization rates, which can sometimes be avoided with proper preventive care. And increasing staff ratios is not just about protecting the health and safety of residents, she noted, but also about improving their quality of life.

CNAs who testified at the hearing echoed these concerns. Cheryl Roberts, a caregiver on the overnight shift who is responsible for 19 residents, said her patients sometimes must wait an hour until she can get to them and she worries about someone falling out of bed while she is occupied. “It’s not right when we’re expected to be in two places at the same time. And it’s not fair to our residents,” she said.

Margaret Boyce, a CNA from Elizabeth who has been on the job for more than three decades, said she often cares for 15 or 20 patients during her day shift, more than twice the number she was responsible for back in 2002. The hardest part, she said, is when a lonely resident wants to share a story or reminisce, but she doesn’t have the time to listen.

Already a shortage of caregivers

“I don’t know what went wrong but today the number (of patients under my care) has doubled. Not only that, but today our residents are older and require more care,” including lifts that need two CNAs to safely operate, Boyce explained.

Nursing home operators and industry leaders praised the role CNAs play, but stressed that there was already a significant shortage of these critical front-line caregivers. Requiring staffing ratios would only exacerbate this problem, they noted, and they stressed the need for better staff development and supports for these workers.

Theresa Edelstein, with NJHA, urged the state to create a reciprocal system with other states to enable individuals certified outside New Jersey to work here and urged the state to create scholarships and tax credits to help encourage more CNAs to become trained. State-mandated hiring minimums could cause unintended consequences, she noted, driving up costs for nursing homes and possibly forcing some to close.

The New Jersey Business & Industry Association outlined similar fears and agreed more needs to be done to expand the pool of potential caregivers. “This legislation would increase overall nursing home costs, at a time when rising healthcare costs continue to be a top concern for all NJBIA members,” NJBIA vice president Mary Beaumont said in written testimony.

The measure — also sponsored by Assemblymen Raj Mukherji (D-Hudson,), Thomas Giblin (D-Passaic), Paul Moriarty (D-Gloucester), and Assemblywoman Valerie Vainieri Huttle (D-Bergen) — now heads to the full Assembly. A Senate version awaits an initial hearing.