26 May 2021: How COVID Drove Changes in NY State Laws for Nursing Homes

Nursing Home COVID Deaths Lead to State Staffing Rules

This article explores some of the thinking behind the changes New York lawmakers made to nursing home staffing requirements:

At the height of the COVID-19 pandemic, New York state moved many critically ill patients from hospitals back to nursing homes, contributing to as many as 15,000 deaths.

There were bodies piled in refrigerated trucks. Family members, prohibited from being with loved ones in their last moments of life, cried outside nursing homes, hands pressed against the glass. Meanwhile, swamped and exhausted nursing home workers struggled to provide care.

In many nursing homes, there just weren’t enough workers—many of them were sick or terrified themselves—to care for so many critically ill and dying residents. Now that the pandemic is finally loosening its grip, New York and several other states are setting higher standards for nursing home staffing.

A bill passed by the New York Senate and Assembly, which Democratic Gov. Andrew Cuomo is likely to sign, would require nursing homes to provide a daily average of 3.5 hours of care per patient by a nurse or nursing assistant. A separate budget bill, also passed by both chambers, would require nursing homes to spend 70% of their revenue on patient care. Of that 70%, at least 40% would have to go toward paying nurses.

While there are some federal and state standards in place for staffing, experts say the rules are easily circumvented.

"The COVID-19 pandemic has exposed how understaffing in our healthcare facilities, especially at our embattled nursing homes, can lead to a dangerous environment for residents and workers,” state Sen. Gustavo Rivera, the Democratic chair of the Health Committee and chief sponsor of the bill, said in an email to Stateline.

The article also explores why those measures are unlikely to be successful, which is based on economic thinking:

But Assemblymember Josh Jensen, a Republican, said setting staffing thresholds might make it more difficult for nursing homes to fulfill all their responsibilities to residents. Jensen spent a year as the director of communications in a nursing home in his upstate district before his election to the Assembly last November.

“I saw in my experience how challenging the situation was before COVID and the struggles they were facing [with getting enough staff],” Jensen said. “This bill is going to tie the hands of nursing homes and take away the resources they need for the entirety of nursing home care.”

Jensen also said the $64 million lawmakers annually put in the state budget to help nursing homes hire more staff is not enough. New York, he said, is “just putting in more mandates with not enough financial support.”

Not explored is how the legislation might affect the quality of care available at nursing homes. Without additional funding, nursing home operators may be forced to populate their staffs with lower-paid, less qualified, and less productive nurses to meet the state's arbitrary staffing level mandate. At a certain point, throwing more people at the problem cannot overcome a general degradation in quality of care for patients.

Also not mentioned is the apparent lack of enthusiasm of nursing home staff to be vaccinated for COVID-19 in New York. In New York City, the epicenter for COVID infections in the United States, that figure can be has high as 60% among nursing home staff members. With nursing home workers a primary vector for spreading coronavirus infections within nursing homes, having larger numbers of unvaccinated workers around does not bode well for maintaining staff levels or slowing the spread of infections for the next pandemic.

Which is not to say that what New York's lawmakers did isn't an improvement over the situation that existed in New York before, it's more to say they have much more room for improvement because they don't fully understand the issue.