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RI House to vote on compromise nursing home staffing bill

Providence Journal - 4/28/2021

PROVIDENCE — A proposed compromise in the politically charged, union-driven fight for minimum staffing mandates at Rhode Island nursing homes is headed for a key committee vote Thursday.

House Speaker K. Joseph Shekarchi said the reworked bill that came to light for the first time on Tuesday attempts to bridge the divide between the Service Employees International Union and the nursing homes warning of mass closures.

The mandate would be phased in over two years. The minimum number of required hours per patient per day would be lower than in the Senate-passed version, and would include time spent with physical therapists, speech pathologists and other medical professionals.

In an interview earlier this week, Shekarchi said the reworked bill "balances the desire to improve health-care quality and patient care ... [with] the industry's perspective."

While deferring comment on the proposed compromise, Senate President Dominick Ruggerio said: “This legislation has been a priority for the Senate."

The minimum staffing bill loomed large over the 2020 elections amid an aggressive union drive to oust any state lawmaker unwilling to commit to the mandate, including then-House Speaker Nicholas Mattiello.

With the SEIU aggressively campaigning against him last fall over his backing a study over an immediate vote, Mattiello circulated an endorsement from Scott Fraser, executive director of a nursing-home owners' advocacy group, the Rhode Island Health Care Association.

Hailing Mattiello for standing up for the nursing homes and their residents, Fraser's letter accused "a local and national union'' of trying to "grow their union membership'' by pressuring legislators to support "an unfunded $44-million staffing mandate [that] would put homes out of business."

"Instead of blindly passing a bill claiming to be for the workers in our nursing homes, he listened to both sides," the letter said.

But Mattiello — who faced political demons on multiple fronts — met defeat anyway in November, paving the way for the current House Speaker, Shekarchi, to appoint a five-person working group to seek a compromise.

The group included Democrats at both ends of the party's liberal-to-conservative spectrum: Representatives Gregg Amore, Jason Knight, Charlene Lima, Scott Slater and June Speakman.

In the interim, SEIU 1199 New England resumed its fight for the minimum-staffing mandate, submitting testimony to lawmakers in March that sought to link the coronavirus death toll in Rhode Island nursing homes — "the third-highest per capita rate in the country" — to staffing levels, which the industry vociferously disputed.

The union contended the industry's financial woes are overstated, especially in light of said the $2.5 billion in federal coronavirus aid aimed directly at "address(ing) low staffing and PPE costs" in nursing homes.

"In fact, a quarter of the nursing homes in the state exceed or are very close to the 4.1 hours per day of direct care recommended by the Centers for Medicare and Medicaid," the union argued.

"On the other hand there are the bottom feeders many of which provide less than 2.5 hours of care per day per resident. It is time for accountability and to level the playing the field for nursing home residents and their families."

The Senate-passed version of the bill would require 4.1 hours of nursing care per resident per day. The proposed House version would require a "quarterly minimum" of 3.58 hours starting on Jan. 1, 2022, and 3.81 hours starting on Jan. 1, 2023.

The Senate's definition of "direct caregiver" is narrower than in the House version, which in addition to nurses and CNAs includes physical and occupational therapists and speech-language pathologists.

Unlike the Senate version, the House's contains penalties of up to 300% of "the cost of wages and benefits for the missing staffing hours'' and, in persistent cases, a hold on Medicaid reimbursement.

Another difference: The Senate bill would require that any rate increase go directly to pay increases for direct-care workers. In the House version, 80% would have to go to increases in "compensation and benefits."

"Not happy about it,'' said James Nyberg, executive director of LeadingAge RI, which is one of the two nursing home lobbies at the State House.

Agreeing, Fraser said Wednesday: "The bill is an unfunded mandate which will also result in a reduction of quality of care.

"Money will have to be taken from quality measures to try and fill staffing requirements. ... It is bad public policy and will result in the closure of nursing homes."

"Even if this bill provided adequate funding to meet the guidelines, this sets a standard that just can’t be met. The people needed to fill these vacancies just do not exist,'' he added.

But in response to a Journal inquiry, Patrick J. Quinn, executive vice president of District 1199 SEIU New England, described the reworked House bill as "a compromise that represents an important step forward to improving the lives of thousands of seniors and people with disabilities while providing a pathway out of poverty for dedicated frontline caregivers, most of whom are women and people of color."

SEIU 1199's partners in the campaign for a minimum staffing requirement include: the Senior Agenda Coalition of RI, Women's Fund of Rhode Island, Economic Progress Institute, the Rhode Island AFL-CIO, and the Rhode Island Coalition Against Domestic Violence.

This article originally appeared on The Providence Journal: RI House to vote on compromise nursing home staffing bill

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