Biden's nursing home staffing fix is not enough
A nursing home in Uniondale. Neither the federal or state staffing requirements even begin to solve the issues that plague nursing homes. Credit: Newsday/Jessica Rotkiewicz
A year-and-a-half ago, in his State of the Union address, President Joe Biden briefly highlighted the need for better nursing home care, saying Medicare would "set higher standards" and "make sure your loved ones get the care they deserve and that they expect …"
In this year's speech, Biden again flicked at nursing homes, saying his administration was "protecting seniors' life savings by cracking down on nursing homes that commit fraud, endanger patient safety or prescribe drugs that are not needed."
Last week, Biden finally emerged with one key proposal: minimum staffing levels.
But the policy barely scratches at the surface of what nursing homes must do to give our loved ones "the care they deserve and that they expect."
The federal standard amounts to three hours of care per resident per day from a combination of registered nurses and nurse aides. That's lower than what advocates sought and lower than even the 3.5 hours of care New York State began requiring last year.
While nursing homes in New York likely will still have to meet the higher state standard, the discrepancy already has caused some confusion. And neither requirement even begins to solve the far more intractable issues that plague nursing homes.
That's partly because staffing requirements aren't magic. Biden or Gov. Kathy Hochul can say nursing homes have to add staff but that doesn't mean institutions can — or will. It doesn't mean new workers will have the necessary skills and training. And with an exemption to the federal rule for cases of worker shortages, even the minimums may not stick.
The COVID-19 pandemic shined a large spotlight on troubles festering in nursing homes long before a woman in a facility in Washington state was diagnosed with the first U.S. case of coronavirus in February 2020 and long before the virus spread through long-term care facilities across the country, including those on Long Island.
While the pandemic's horrific impact exposed the inadequate care and led to an outcry and demands for reform, little has changed. Many homes still lack appropriate personal protective equipment, infection control procedures and proper hygiene practices. Many still lack oversight, accountability and owners who put money back into the facility, rather than pocketing the profits. And, yes, many still lack enough trained staff — people who know how to care for our most vulnerable residents, and who care about the job they do.
As a result, there have been too many instances of tragic, preventable deaths, injuries to residents and more.
The spotlight, meanwhile, has waned, allowing the many troubled nursing homes in the region and beyond to continue to operate as they always have.
On the surface, it might look like adding staffing requirements is a fix. But it's hard for most service industries to hire enough employees. The work that's required of a nurse or aide in a nursing home is all the more skilled, difficult and thankless. Yet, care of our most vulnerable is one of the most important values of our society and we must get this right.
It makes little sense to introduce staffing mandates without tying them to incentives, bonuses, training opportunities and other ways to lure talented and committed workers to the industry — and keep them there. And it makes little sense to add such mandates without addressing the underlying problems. It'd be like decorating your home with curtains and paint without fixing the badly-cracked foundation and walls.
Sooner or later, the house will collapse.
Columnist Randi F. Marshall's opinions are her own.
Randi Marshall is a member of the Newsday editorial board.
