New York’s budget does not go far enough to help nursing homes provide care – one reason Sen. George Borrello, R-Sunset Bay, voted against the spending plan.
The $220 billion spending plan includes more than $5 billion to pay for health care worker wage reform and bonuses. That money includes $1.2 billion for retention bonuses for health and mental hygiene workers, with up to $3,000 in bonuses for workers earning less than $125,000 who remain on the job for a year, and prorated bonuses for those who work fewer hours. Another $500 million will be spent on cost-of-living adjustments to boost the salaries of social service workers. The budget also includes a 5.4% cost of living adjustment for social service workers.
There is also money for health care infrastructure improvements for hospitals, nursing homes, ambulatory care centers, community centers and other qualifying health care facilities and providers.
But there’s no money to help nursing homes provide care and meet rising state standards for staffing per resident and the percentage of revenue to spend on patient care. . Borrello asked Sen. Gustavo Rivera, D-Bronx and chairman of the Senate Health Committee, regarding funding for nursing homes included in the 2022-23 state budget.
“As you know, these facilities have had to deal with years of Medicaid cuts,” said Borello. “Our former governor was very good at reducing those reimbursements, and right now, in fact, the average is about $211 a day that we reimburse through Medicaid to nursing homes, which is a shortfall of about $55 per day compared to actual cost of care on average. In the meantime, I will point out that two years after the Medicaid redesign team identified, and I have also identified, the gross waste fraud and abuse in Medicaid non-emergency transportation funding where we pay drivers taxi rides to drive people to non-emergency medical appointments, in my area a single trip to a Medicaid-paid doctor’s office can cost up to $350 round trip. So we pay a taxi driver $350 to drive someone to a doctor’s appointment and meanwhile we pay a nursing home, with all the expenses of caring for people, $211 a day. So my question is are we going to do something about that, are there other funds in this budget to help our care homes that are struggling? »
The state’s minimum staffing standards include 3.5 nursing hours per resident per day. Of the 3.5 hours, at least 2.2 hours of care per resident can be provided by a licensed practical nurse or certified practical nurse, and at least 1.1 hours must be provided by a licensed practical nurse or registered nurse. Starting in January, nurse aides will need to be certified to meet minimum hourly requirements. The Department of Health will review compliance quarterly by comparing the average daily number of hours provided per resident, per day, using the most recent data available from the Centers for Medicare and Medicaid Services Payroll-Based-Journal ( PBJ) and the average daily census of the establishment.
The regulations authorize civil penalties of up to $2,000 for each day a facility fails to meet minimum staffing standards. The Department of Health may take into account disaster emergencies, the frequency with which nursing homes fail to meet standards, and the existence of labor shortages in particular areas of the health system. state to decide the penalty, but nursing homes cannot justify lack of compliance solely by not being able to find workers.
Rivera said there will be some penalty relief by pro-rating penalties for facilities that do not comply with state personnel and expense regulations. Rivera also noted that some earlier Medicaid funding cuts were reinstated as part of the budget.
“First of all, there were cuts that we reinstated from years past to the extent that across the board, the Medicaid cuts that our esteemed predecessor, the deceased, as I call him, actually imposed “, said Rivera. “We got them back. This is something that is generalized, which means that it also concerns care homes. And there’s also a pool of capital money that we wanted to make sure there were particular chunks that were available to nursing homes. I believe there is $25 million in this budget for capital improvements. It would be a fund that they could draw money from to be able to do capital improvements in nursing homes.
Nursing home advocacy organizations have estimated that at least 12,000 new workers are needed statewide to provide such care at a time when nursing homes are already struggling to find workers. To avoid the most severe state penalties, nursing home owners must also show that they have made reasonable efforts to find enough staff during the period of non-compliance, including incentivizing new staff with a increased wages and benefits and by hiring in areas outside of its location. In addition, the facility must demonstrate that it has taken steps to ensure the health and safety of residents despite any labor shortages, such as halting admissions, closing units, or transferring residents to another appropriate institution.
“What’s going to happen?” Borrello asked. “They have a requirement, thanks to New York State. They will therefore have to close beds, close wings, close facilities. It’s not a theory. I have spoken with care home owners who have told me these are tough decisions we will have to make. When you live in a rural area like mine, you can’t just walk down the street and find another facility for your loved one. You may need to take them home and take care of them yourself. You may need to place them in a facility far, far away. People who have memory problems, it’s going to be very disturbing, very traumatic. There is nothing in this budget to remedy that and it is rather tragic. I think we really have to take a serious look at who are we trying to please, who are we trying to please, with this 70-30 rule and these staffing rules. It’s not the locals. It’s not the people who want to be cured, who need to be cured. They are special interest groups. And you can dress that up because we’re going to provide better care. … We’re at a point where we don’t have the people to do it.
Borrello and Rivera discussed how this funding would be available. Rivera said guidelines will be drafted by Gov. Kathy Hochul and the state’s health department, with the goal of helping nursing homes that have little capacity to complete nursing projects on their own. expensive investment. Borrello asked if nursing homes that provide a high standard of care will be able to access the capital projects fund or if they will be excluded from state funding because they have the ability to raise funds by other means.
“It would be hard to say” said Rivera. “It is probably possible that even a one-star establishment in terms of quality at any given time would qualify. Remember that we are talking about projects that aim to make this establishment more capable of providing care. It’s possible we should look at the particular situation, I can’t tell you that in every possible case, but it’s possible that there is an installation that, although it doesn’t have a very high quality rating high before the project was done, might argue that the project is needed to actually help them provide better care. It is possible for such a thing to happen, but I cannot tell you in all possible cases.