Op-Ed: Protect Vulnerable Seniors by Improving Staff Levels in NJ Nursing Homes

Milly Silva, Evelyn Liebman | June 13, 2019 | Opinion
A bill that would establish minimum CNA-to-patient staffing ratios in nursing homes has been delayed for more than a year; it’s time for the Assembly to act

Ev Liebman (left) and Milly Silva
Ella Moton is a certified nursing assistant at a nursing home in Jersey City who provides critical bedside care to 12 elderly residents each day. Ella’s career choice is one of passion — her $11.59 hourly wage certainly isn’t the reason she has kept at it for nearly 20 years — and she can recount many times when she’s touched the lives of people in their most trying times, through gestures as simple as an affectionate hug or offering a familiar hand to hold. One of her former residents was a Tuskegee Airman, and Ella took special pride in providing care and comfort to him during his last days. But, Ella says, short staffing oftentimes inhibits her ability and that of her co-workers to provide the person-centered care their residents deserve. “Someone like him should never have to sit alone in the corner all by himself because there aren’t enough nursing assistants to give him compassionate care,” she testified at an Assembly hearing last year.

Right now, New Jersey lawmakers have the chance to make a real, meaningful improvement to the lives of thousands of seniors across our state by passing a bill to improve staffing levels in nursing homes. Today, there are some 44,000 seniors and people with disabilities who live in nursing facilities. For many people this type of 24/7 care is often the last and best option for those whose health issues prevent them from remaining at home, the preferred choice for most families. Individuals who need to enter nursing homes often do so with acute health challenges and require assistance throughout the day in fulfilling their basic needs of living.

We depend on nursing homes to provide the scope of care and services that will ensure that our loved one’s well-being is maintained. Proper staffing levels are critical to this scope of care. Nursing facilities need care from registered nurses with clinical responsibilities on duty 24 hours a day, seven days a week, and a strong frontline workforce — the certified nursing assistants (CNAs) who provide the overwhelming majority of direct care such as feeding, dressing, and bathing residents, repositioning residents in their beds to prevent pressure sores, and providing emotional support and comfort to residents during difficult and lonely times.

Even so, New Jersey nursing homes have consistently ranked among the very worst in the nation in important direct care indicators. According to federal data, the state currently ranks 45th for the average hours of daily care that patients receive from their CNAs.

AARP’s Long-Term Scorecard ranks New Jersey 41st in the nation for the percent of high-risk nursing home residents diagnosed with pressure sores, 46th for the percent of residents with moderate or severe dementia who experience burdensome transitions at the end of life, and 35th in the nation for the percent of people who are able to successfully move back to their community after a 90+ day nursing home stay.

This status quo is unacceptable.

Law in New Jersey is inadequate

New Jersey’s current regulatory framework for ensuring adequate staffing in nursing homes is simply inadequate and compromises patient safety. The Centers for Medicare & Medicaid Services (CMS), the federal agency that administers the nation’s two largest health programs, has conducted research finding that facilities that provide less than 4.1 hours of daily total nursing staff care per patient “may provide care that results in harm and jeopardy to residents.” Yet under current New Jersey law, facilities are required to provide only 2.5 hours of total care, plus 0.75 hours to 1.5 hours if the patient requires special services such as wound care or intravenous therapy.

CMS has also pointed to research finding that for CNA staffing hours alone (excluding other nursing staff), levels to ensure “minimally necessary” care range between 2.8 and 3.2 hours per resident day, and this assumes “a very highly motivated and productive nurse aide staff.”

The time for change is well past due. A few years ago, legislators passed a bill to establish minimum CNA-to-patient staffing ratios in nursing homes. These ratios would be one CNA per eight residents during the day shift, one CNA per 10 residents in the afternoon, and one CNA per 16 residents overnight. While even this standard would not bring the hours of daily resident care up to the threshold recommended by CMS, it represents an important step in the right direction — while establishing a clear and enforceable ratio system for patients and their families to understand. Unfortunately, then-Gov. Chris Christie vetoed the bill.

Last July the New Jersey Senate voted to pass bill
S-1612/A-382, an identical bill to the one passed previously.

We are asking for the Assembly to pass the bill and send it onto Gov. Phil Murphy for signature. The stakes are too high for the tens of thousands of vulnerable New Jerseyans who depend on the type of round-the-clock care that nursing homes provide. It is in the vital public interest to insist that our state invest the necessary resources to ensure that enough nursing aides are available for every senior who needs care and a hand to hold onto in their final moments.