New regulations would improve care for nursing home residents

The COVID-19 pandemic has had a devastating impact on the long-term care system in Pennsylvania. Long-term care residents have accounted for 48% of COVID-19 fatalities statewide, according to data from the Pennsylvania Department of Health. 

Even before the pandemic, alarms had already sounded on the vulnerabilities of the nursing home industry in the Commonwealth. In 2019, the Pennsylvania Long-Term Care Council issued “A Blueprint for Strengthening Pennsylvania’s Direct Care Workforce” calling attention to the crisis level of understaffing in Pennsylvania nursing homes. The report cited low staff pay, minimal training, and the physically and emotionally challenging nature of the job as factors that made it difficult to recruit and retain direct care workers in long-term care settings. These staff shortages and frequent worker turnover negatively impact the health and well-being of the residents who rely on these professionals for their care. 

COVID-19 further exposed many of these long-standing shortcomings. Facilities most often did not have the infrastructure in place to prevent the spread of the virus, including a lack of personal protective equipment (PPE) and training in its proper use. Understaffing was worsened when direct care workers contracted COVID-19 from working in hazardous environments, leaving residents with less care at times they needed it most. Staff who had to work at multiple facilities in order to make a living wage may have inadvertently spread the virus between nursing homes.

Now, for the first time in 25 years, Pennsylvania is revising its nursing home regulations to increase the standards for nursing home care. Most notable in the proposed regulations is an increase in the required hours of direct resident care per day. Essentially, this figure defines the amount of time that must be spent with each resident during a 24-hour period by registered nurses, licensed practical nurses, and certified assistants. These hour requirements help to establish a baseline for the number of nursing personnel needed in a facility.  

The current regulations require only 2.7 hours of daily care per nursing home resident. The newly proposed regulations would increase this number to a minimum of 4.1 hours per resident per day. This increase would finally bring the state in line with 20-year-old recommendations from the Centers for Medicare & Medicaid Services that establish 4.1 hours as the minimum needed to provide sufficient care to nursing home residents.

Raising the state staffing standard would positively impact both nursing home residents and workers. Receiving more daily care reduces a resident’s risk for falls, bed sores, malnutrition, dehydration, and infections. It will also, in most cases, require that facilities hire more staff, allowing direct care workers to spend more time with the people they care for instead of having to rush to see more residents than they have time for. 

As LGBTQ advocates, these proposals warrant our attention given how our communities are going to interact with the long-term care system. The Administration for Community Living reports that 70% of people age 65 and over will need some form of long-term nursing care at some point in their lives. This figure is likely even higher in our LGBTQ communities given the number of older LGBTQ individuals who live alone without spouses or children to help provide care in the home. In these cases, LGBTQ people are more likely to have to rely on professional caregivers, such as home health aides, or on placement in institutional settings such as nursing homes.  

There is a tremendous amount of work to do to ensure that these nursing home settings are affirming and responsive to the needs of our communities. We need facilities to have non-discrimination polices that protect LGBTQ people from mistreatment by staff and other residents. We need staff to be trained in LGBTQ cultural sensitivity and best practices for providing LGBTQ-affirming care. 

Developing an LGBTQ inclusive nursing home environment takes time and commitment from all levels of staff, which is difficult to do at a time when understaffing is at a crisis level, staff turnover is high, and workers don’t have enough time to spend caring for residents. Once facilities are no longer dealing with staffing crises, they will be better able to work towards greater LGBTQ inclusivity and cultural sensitivity.

The proposed regulations on nursing home staffing are the first of five regulatory packages on Pennsylvania nursing homes expected to be released this year. A public comment period on the proposed staffing increase is open until August 31, 2021. Comments can be submitted to the Department of Health via email at [email protected].

David Griffith is the director of Programs & Outreach at the LGBT Elder Initiative.

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