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Nursing home minimum staffing law takes effect in NY

The state capitol in Albany
Dave Lucas

Governor Kathy Hochul’s administration has lifted a three-month pause on a new law that will require nursing homes in New York to meet minimum standards for staffing and patient care.

Advocates for the law, which creates minimum staffing ratios and requires that nursing home residents get at least 3.5 hours per day of direct nursing care say they are relieved that the delay is over.

Julie Martinez, a member of the health care workers' union 1199 SEIU, and a nurse at the Dunkirk nursing home in western New York, says there have been times in the past couple of years when she has been the only registered nurse on duty for 40 residents. She says it’s “heartbreaking” to be unable to meet even the basic needs of residents, like helping them use the bathroom, or getting them a glass of water.

“The staff is crying because they know that the residents are not getting quality care,” Martinez said. “They deserve it, and we can’t give it to them.”

She says residents went for months without visitors earlier in the COVID-19 pandemic, and sometimes they just needed to have a conversation. She says she hopes the new staffing minimums will now make that possible.

1199’s Executive Vice President Milly Silva says the state’s nursing homes had inadequate staffing even before the pandemic.

“COVID exposed what already existed in the nursing homes,” Silva said. “And really brought home why it was so necessary that we enact the reforms that have been put into place.”

The law, approved in 2021, was in response to the nursing home crisis during the pandemic, when 15,000 residents died from the disease.

Attorney General Tish James in January 2021 issued a report on the nursing home industry, which found that former Governor Andrew Cuomo and his aides undercounted by 50 percent the number of nursing home deaths during the height of the pandemic. The report also documented severe weaknesses in the system, including chronic understaffing at many facilities. Cuomo resigned in August.

The law also requires that 70 percent of each nursing home’s revenue goes toward patient care, with 40 percent used to pay workers.

Nursing home operators reacted with dismay. They argue that they can’t afford to hire an estimated 12,000 new workers. And they blame New York state lawmakers for not including any cost-of-living adjustments in the Medicaid reimbursement rates for the past 14 years. Three-quarters of patients pay for their care through the government-funded health care system.

Jim Clyne is president of LeadingAge NY, which represents publicly-owned and nonprofit nursing homes. Clyne, speaking before Hochul allowed the law to take effect, said the nursing homes in his group would support the measure if the state provided adequate funding.

“If they came up and actually paid for the cost of care that they claim they want to provide, we would actually support that,” Clyne said. “But the state has a long history of not providing the reimbursement that’s needed.”

After the governor’s decision, Clyne said in a statement that Hochul and the legislature are making a “false promise” to nursing home residents and their families. He says 80 percent of his members won’t be able to comply with the new rules, and will have to close down units or reduce beds.

The law comes with enforcement mechanisms. Helen Schaub, also with 1199, says the state health department will be checking up on the nursing homes to make sure that they comply with the staffing requirement, by examining payroll data that the homes must file with the federal government.

“The homes are required to report their staffing on a daily basis, showing payroll records,” Schaub said. “So they can’t just self-report as they did in the past.”

Fines for noncompliance could be up to $2,000 a day.

Also under the law, the state can seize money from nursing homes that don’t spend the required amount of their revenues on patient care. Some nursing homes have filed a lawsuit, saying that would be an illegal taking of private property.

Karen DeWitt is Capitol Bureau chief for New York State Public Radio, a network of public radio stations in New York state. She has covered state government and politics for the network since 1990.