Stricter regulations for staffing of Pennsylvania nursing homes go in effect this Saturday

Stricter nursing home staffing requirements are going into effect in Pennsylvania this week, as part of the first major rewrite of the facilities’ regulations since 1997.

Beginning July 1, the Pennsylvania Department of Health will require all long-term care facilities to meet a new standard for the hours of direct care each nursing home resident receives. Facilities will be required to provide 2.87 hours of direct care to each resident daily, up from the 2.7 hours of daily direct care they currently need to provide.

A bigger jump to 3.2 hours of direct care per day is scheduled to go into effect July 1, 2024.

The new regulations also mandate for the first time a minimum number of care staff per shift — for example, one nurse’s aide for every 12 residents and one licensed practical nurse for every 25 residents during day shifts.

» READ MORE: Pa. nursing homes could be hit with wider swings in Medicaid rates starting next month

The updated policies are intended to improve patient and worker safety as nursing facilities grapple with staffing shortages. Unsafe working conditions have pushed many nursing assistants to leave long-term care facility jobs in recent years, said Matt Yarnell, the president of SEIU Healthcare PA, a labor union that represents thousands of nursing home workers. The pandemic exacerbated the trend, he said, but the new staffing standards could bring workers back to the bedside.

“The new ratios will make sure we never experience the overwhelming sickness and loss of life that we did this past three years,” Yarnell said Friday.

There are roughly 700 nursing homes in Pennsylvania housing nearly 90,000 people, according to a recent U.S. Senate report.

Liz Wright, a certified nursing assistant for 30 years in the Harrisburg area, said that staffing shortages harm patients. Residents eat meals in their beds or wait a long time to go to the bathroom because the nurse’s aide doesn’t have enough time to tend to their needs.

“We’re always rushing to get everything done,” Wright said. “This is supposed to be their home, and you shouldn’t have to rush in your home.”

The health department is required by federal law to inspect each nursing home once every 15 months, and that will include ensuring compliance with the new standards, said Jeanne Parisi, deputy health secretary for quality assurance.

“We will cite a facility that’s failing to meet these ratios,” Parisi said.

» READ MORE: Sen. Bob Casey worries that nursing homes are ‘uninspected and neglected’

Last month, a U.S. Senate Special Committee on Aging helmed by Pennsylvania’s Sen. Bob Casey released a report that found that one in four nursing homes nationwide was not inspected in the last 16 months, as required. Pennsylvania, like most states, has a shortage of nursing home inspectors.

Pennsylvania nursing homes will need to hire 1,400 nursing aides to meet the new standard, Gloria Gilligan, who leads the Office of the Budget within the Department of Human Services, estimated at a Senate budget hearing in March. Pennsylvania has 66,800 nursing assistants, according to the Bureau of Labor Statistics, but not all of them work in nursing homes.

The staffing changes go into effect as nursing homes in Pennsylvania could face wider swings in Medicaid rates, according to the Department of Human Services. The department did not provide more details but an Inquirer analysis showed that twice as many nursing homes as last year are facing a cut of 5% or more in their daily Medicaid rate. Industry representatives are worried that some nursing homes might not survive significant cuts.

The push for minimum staffing standards is a rallying cry of health-care workers nationwide.

In Pennsylvania, nurses and the unions representing them scored a win earlier this week when the state House of Representatives passed a bill that would mandate nurse-to-patient ratios in hospitals.

» READ MORE: Pennsylvania House approves bill to require nurse staffing minimums in hospitals

The bill now goes to the Republican-held state Senate, where its passage is uncertain.

Sen. Maria Collett, a Montgomery County Democrat, introduced a similar bill earlier this session, but it never advanced out of committee. Versions of the bill introduced in previous sessions also stalled.

If the bill passes the Senate, Pennsylvania would be among the first states in the nation to enact minimum nurse staffing requirements in hospitals.

“We are so close to getting this done,” Collett, a registered nurse, said in a rally in Harrisburg after the passage of the bill on Wednesday.