When state Attorney General Tish James issued a report late last month on the COVID death toll in New York’s nursing homes, she drew a seriously consequential conclusion, finding that facilities with higher resident death rates were closely correlated to those that were understaffed. Correlation clearly implied causation.
Last week, the state finally published detailed, facility-level data showing the true number of nursing home resident deaths, including fatalities of residents that occurred after people were transferred to hospitals. Virtually every facility in the state, even the best rated ones, reported deaths. It’s hard to know if better staffed nursing homes could have saved more lives from such a deadly contagion.
But what the federal Centers for Medicare and Medicaid Services and a series of independent studies have shown, since long before COVID arrived, is that a clear connection exists between a nursing home’s personnel levels, especially registered nurses, and the health outcomes of its residents. Those studies pinpoint several staffing thresholds below which quality of nursing home resident care was likely to suffer. Among them: When registered nurses provided less than 45 minutes of care per resident per day, or less than 1 hour and 18 minutes of combined nursing services from RNs and licensed nurse practitioners.
Out of New York’s 617 nursing homes, a majority, 417 facilities, have registered nurse staffing ratios under the CMS-recommended minimum daily 45 minutes per resident. Just 50 facilities across the state earned CMS’s maximum rating for nurse staffing.
Legislation that would set mandatory nurse staffing ratios in both nursing homes and hospitals, stalled in the Legislature for years amid concerns about the costs and rigid restrictions it would impose, has gotten new momentum from the COVID crisis.
It needs some major surgery. The argument for mandating fixed ratios in hospitals is weaker than the argument for imposing staffing minimums in nursing homes. California is the only state that requires hospitals to follow such mandates. Data on its efficacy is mixed.
But 38 other states have laws on the books requiring mandatory minimum staff ratios in nursing homes, and those rules do help compensate for federal nursing home staff rules that are much weaker than the ones governing hospital staff levels.
New York should join those 38 states. The change is especially important as the state experiences a rapid increase in conversions of nursing homes from nonprofit to for-profit ownership. For-profit owners’ incentives to maximize their revenues too often mean skimping on patient care.
If lawmakers excise hospitals from the legislation and move ahead with the staffing ratio mandate for nursing homes, they should consider following examples set by New Jersey and Massachusetts, which each imposed requirements that nursing homes spend significant portions of their revenue on patient care and staff. That would prevent them from compensating for added personnel costs by slashing other vitally needed personnel or services.
The COVID crisis may have highlighted the flaws in New York State’s nursing homes, but the understaffing problem long predated the virus. Let’s fix it.
