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NBC 10 I-Team: Nursing home industry calls on Rhode Island lawmakers to stop fines


The Rhode Island Health Care Association is calling for a delay in the minimum staffing law as the proposed fines could lead to closures. File image of assisted living facility. (WJAR)
The Rhode Island Health Care Association is calling for a delay in the minimum staffing law as the proposed fines could lead to closures. File image of assisted living facility. (WJAR)
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A dire plea from Rhode Island’s nursing home industry, as dozens of facilities are weeks away from getting hit with hefty fines unless the legislature steps in.

“We are looking for them to just put a halt to the penalties instead of kicking it a quarter at a time,” Rhode Island Health Care Association President John Gage said.

The Rhode Island Health Care Association, which represents more than 80% of the state’s nursing homes, is calling on lawmakers to immediately delay penalties associated with the Nursing Home Staffing and Quality Care Act through the end of December 2024, warning that not doing so could lead to closures, bankruptcy filings, and admission freezes.

The law, which passed in 2021, requires facilities to provide a specific metric of direct care per resident, per day, or pay a fine. That metric started at 3.58 hours of direct nursing care and 2.44 of direct CNA care, but increased this January to 3.81 hours of nursing care and 2.60 hours of CNA care.

Penalties associated with the law were waved for the first two quarters of 2022, but the look took full effect on July 1, 2022 after a bill meant to provide relief from staffing mandate penalties failed at the last hour of the legislative session.

THIRD QUARTER FINES

As a result, nursing homes statewide will get their first set of fines from the state for the third quarter of 2022 by the end of February, sending the industry scrambling for solutions.

“We expect the penalties to be in the $11 million range,” Gage said.

Data from the Rhode Island Department of Health show if facilities were fined for the second quarter of 2022, it would have cost a total of $11.4 million, with 72% of nursing homes failing to comply with the law.

Gage says if the third quarter fines kick in at the end of the month, nursing homes will be forced to close.

“It will have a devastating impact on the industry,” he said. “The penalties range from a low of $30,000 and go up to just about $1 million per facility with an average penalty of $150,000, so it would be a big hit.”

Penalties associated with the safe staffing law were supposed to start in January 2022.

If that happened, Gage says nursing homes would have been fined a total of $40 million, forcing about 50 of them, or 60% of the state’s nursing homes, to either freeze admissions or pay back Medicaid money to the state.

“The results would have been fines, penalties, repayments, and you can’t bring any new residents into your facility, that is a death sentence,” he said.

STAFFING SHORTAGES

The nursing home industry has been hit hard by the pandemic, prompting staffing shortages nationwide.

While Gage says he understands the goal behind the safe staffing mandate, the employees simply aren’t there.

“I think I understand the intent of the law, more staff and better care,” he says. “It sells well, but the bill was unfunded, and it was implemented in the midst of a workforce crisis resulting from the COVID-19 pandemic that no one could’ve expected.”

Gage says while they’re addressing the workforce shortage, financial penalties will only hurt those efforts.

“To implement fines and penalties because we’re simply unable to comply, not choosing not to comply, but unable to comply because there is not the workforce to enable us to do so, would be wrong," Gage said.

According to RIHCA, Rhode Island has lost 20% of its nursing home workforce, or about 2,000 employees since the start of the pandemic.

“Other segments of the health care sector have recovered for the most part, but nursing homes are still down,” Gage said.

RIHCA is participating in new initiatives to try and bring workers back, including working with the Department of Health to resolve testing backlogs for CNA applicants.

The state also gotten approval for an online CNA training program, which will allow for more capacity and efficiency among prospective CNA’s.

Still, Gage says the results won’t happen overnight.

“How long it’s going to take us to recover depends on the economy. I think if the economy slows or goes into a recession, we have longstanding stable jobs for people to go to and that may actually help us with the recovery,” he said. “But that’s going to take quite a while, which is why we’re asking them to delay it until at least next year.”

In the longer term, RIHCA is also calling on the legislature to change the existing statute to fund the mandate, broaden the definition of Direct Care Workers, restructure the methodology used to determine fines, and give RIDOH discretion with determining non-compliance, to allow them to take factors such as staffing shortages, recruitment efforts, patient acuity and quality of resident are into consideration.

Ultimately, any restructuring of the law or penalty delays would fall on the legislature.

House Speaker Joseph Shekarchi and Senate President Dominick Ruggerio sent the following statement about RIHCA’s requests:

“We have met with representatives of both the nursing home industry and advocates for the safe staffing law we passed in 2021. Along with the Governor’s Office, we are continuing to work on this difficult and complex issue," the statement said.

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