While reading obituaries in this newspaper and elsewhere, I’ve often noticed that many people express deep gratitude for the care and support their loved ones have received from nursing home staff. My own grandfather benefited greatly from such care during his final years, and so does a dear friend of mine who now resides in a memory care facility in Bangor. That’s why I’m so troubled that Republicans in Congress are seeking to block the implementation of a new rule, announced by the Biden administration, that seeks to establish minimum staffing requirements for all nursing homes.
Holding to these standards would go some distance toward guaranteeing both proper staffing for our loved ones and proper support for their hard-working and dedicated care workers. As a faith leader and justice advocate, I’d like us to embrace even more generous staffing standards, but the new Biden rule is an important step in the right direction, a step that we should welcome.
The call to increase staffing in nursing homes gained momentum on the heels of the COVID-19 pandemic, during which more than 200,000 nursing home workers and residents died. It’s quite telling that the nursing homes that experienced fewer COVID-19 cases and fewer deaths were the ones with better staff-to-resident ratios.
The new rule is modest. It requires nursing homes to have a registered nurse on site 24 hours per day, seven days a week, and it gives nursing homes five years to meet this requirement. Once implemented, it will require that all residents receive at least three hours and 29 minutes of direct care each day. At least two hours and 27 minutes of that care must be provided by CNAs and 33 minutes by an RN.
To illustrate how modest this rule is, on average nursing homes in Maine provide 4 hours and 21 minutes of total direct care per day, far exceeding both the CNA and RN requirements. The good news is that Maine nursing homes already provide exceptional staffing to their residents, for which we should be grateful.
Rather than getting behind this much-needed staffing standard, Republicans in Congress have introduced resolutions and legislation that would bar the rule’s final implementation and prevent the federal government from ever issuing any safe standard in nursing homes. Even Sen. Angus King has expressed concern about the rule’s effect on veterans and their care.
While I appreciate Sen. King’s regard for the well-being of veterans, it’s heartening to know that the five veteran’s homes in Maine already provide staffing that exceeds this newly established minimal staffing standard. Therefore, these facilities for veterans will not be affected by the new rule. By way of contrast, there are some nursing homes that will struggle to meet the standard, and it’s no real surprise, is it, that these are overwhelmingly for-profit homes located in non-rural areas? Altogether, Maine has 82 nursing homes, 58 of which are for-profit and 24 non-profit. Again, it’s good news that all but one of the non-profit nursing homes already meet the new staffing requirements. Others will need to play catch up to overcome genuine staffing shortages, so the new rule allows for an interim period in which they will be eligible for hardship exemptions.
Of the 58 for-profit nursing homes in Maine, 18 do not meet the CNA standard, and five do not meet the RN standard.
These homes are located in non-rural, high-population areas. CNAs are the backbone of nursing home care, providing residents with assistance in dressing, bathing, feeding, ambulating, getting out of bed and countless other activities of daily living. It’s mindboggling that the average CNA hourly wage in the United States is only $17. Given these pitiful wages, many Mainers simply cannot afford to take these jobs, which is why the average annual turnover of direct care staff in for-profit homes in Maine is 59%.
Rather than trying to derail this much-needed staffing rule, both the for-profit nursing home industry and Republicans in Congress should be addressing the real problem: the job-quality crisis that drives CNAs from the work they love and thereby puts nursing home residents at risk.
For-profit nursing homes located in non-rural areas will need to raise wages for CNAs to attract and retain them. I urge Sen. King to reject the efforts by Republicans in Congress and the for-profit industry to remove these new critical protections from nursing home residents and vote against any attempts to block this important rule. The safety and well-being of nursing home residents and the proper support of their dedicated staff depend on our elected officials, on our community and, yes, on us, to do the right thing.
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