The New York State Legislature passed a “safe staffing” bill for nursing homes on Tuesday, requiring that the often understaffed facilities provide at least 3.5 hours of direct nursing care to each resident.
The Assembly passed the staffing bill by a tally of 125 to 25, while the Senate followed soon after by a tally of 52 to nine.
Lawmakers also passed a separate staffing bill for hospitals, mandating they create committees to decide the right staffing ratios for their particular hospital.
The staffing bill for nursing homes is more strict, saying every nursing home resident must receive at least 3.5 hours of care each day, including at least 2.2 hours from a certified nursing assistant and at least 1.1 hours from a licensed nurse.
New York state nursing homes already provide on average about 3.4 hours, according to the Long Term Care Community Coalition, an advocacy group for nursing home residents. However, that figure ranks 32nd in the nation, while a landmark federal study from 2001 says nursing homes residents should get at least 4.1 hours.
Plus, with no minimum threshold, some New York nursing homes fall below the average of 3.4 hours.
“We thought that it was necessary to actually establish a standard,” said state Sen. Gustavo Rivera, D-Bronx, sponsor of the Senate version of the bill, while on the floor Tuesday. “We have three and a half hours where actual people that are professionals, whether it's nurses aides or licensed nurses, actually take care of individuals. We believe that this is necessary. It’s important.”
Staffing ratios have been debated in Albany for years. A previous version of the legislation, the Safe Staffing for Quality Care Act, has languished in the Legislature for over a decade.
However, the proposal gained momentum over the last year due to over 13,000 New York nursing home residents dying of COVID-19. A report by the state Attorney General’s Office found New York nursing homes with lower staffing ratings from the federal government had worse COVID-19 fatality rates than nursing homes with higher staffing ratings.
“The level of care makes a difference in outcomes,” said Assemblymember, Aileen Gunther, D-Forestburgh, sponsor of the Assembly version and a registered nurse. “The level of care means quality of life for many people that we call part of the greatest generations, and they deserve appropriate care.”
While the bill received bi-partisan support in both chambers, several Republicans voted no and expressed concern on the floor.
Assembly Minority Leader Andy Goodell, R-Jamestown, said nursing homes are already hurting financially from low census numbers during the pandemic and the state cutting Medicaid reimbursement rates by 1.5% last year.
“This is the worst time in the world for us to impose huge, unknown, expensive mandates,” he said.
The Legislature is offering some financial assistance to nursing homes. The state budget passed last month includes $128 million over two years to help them hire more staff, although some have said it isn’t enough.
Republicans also expressed concern there simply aren’t enough nurses to hire. A report released last year by the state Department of Health came to that same conclusion, citing a study that predicts New York could have a shortage of over 39,000 registered nurses by 2030.
Republicans also noted that the 2021 state budget passed last month already requires nursing homes spend at least 40% of their revenue on direct care staffing.
“Why not wait for the potential implementation of that requirement before adding another mandate?” asked Assemblymember Josh Jensen, R-Greece.
Rivera was unapologetic about pairing the staffing ratio with the 40% spending mandate. He said 60% of the state’s non-profit nursing homes are already meeting the 3.5-hour requirement, while only 29% of the state’s for-profit nursing homes are.
“All of these bills are about dissuading bad actors from being in this business,” he said. “It is about making sure that those folks who are good actors can provide the care that's necessary to these folks that are in such need.”
The bill had originally called for nursing home residents to receive at least 4.1 hours of direct care each day, which would be in line with the federal study from 2001. Sponsors of the bill said it was lowered to 3.5 as part of negotiations with nursing homes.
“This probably isn't the last time we will amend this, but I think this is a step in the right direction,” Gunther said. “And everything that we heard during this pandemic about long-term care, the time was really now to be able to address these issues.”
The bill now heads to the desk of Gov. Andrew Cuomo, who has backed nursing home reform this legislative session while facing a federal investigation over his handling of nursing home death data.
If signed into law by Cuomo, the bill will take effect Jan. 1.