Rule would make some nursing homes hire more RNs

By Ashley Griffin

Nursing home reform approved in 2010 sought to address problems in some of the state’s long term care facilities by increasing staffing levels. But sponsors of the legislation say that some for-profit nursing homes have found a loophole in the law.

In the wake of a series of Chicago Tribune investigations that exposed abuse and neglect that resulted in the deaths of some nursing home patients, the reforms pushed to increase staffing levels at nursing homes and tighten existing criminal background checks of incoming nurses and patients. The law requires that by 2014, patients receive a minimum of 3.8 hours of direct care a day. That number is up from the 2.5 hours required before the law. The reforms also require that .75 hours — 46 minutes a day — of that care be provided by a nurse.

But the 2010 legislation does not distinguish between registered nurses (RNs) and licensed practical nurses (LPNs), who do not have to undergo as much training as RNs. A  new rule expected to come up Tuesday before the bipartisan Joint Committee on Administrative Rules would require facilities to use RNs for 20 percent of direct care.

Lawmakers who worked on the reforms said that was their intent. “There can be no true nursing home reform without addressing the issue of RN staffing ratios,” says Sen. Jacqueline Collins, a Democrat from Chicago, in a prepared statement.

However, many for profit nursing homes argue that they cannot afford to hire enough RNs to fulfill such a demand. “We are not against improving staffing, but we are against putting in a requirement that sets nursing homes up to fail,” Pat Comstock, executive director of the Health Care Council of Illinois, told the State Journal-Register. Comstock did not return a call from Illinois Issues.

Sen. Heather Steans, who was a sponsor of the reforms, said that a revenue stream was built in to pay for higher staffing levels. “I very much urge the JCAR members to support and pass the rule. I think it will very much help improve the quality of care in our nursing homes. We also passed the bed tax, which was primarily to fund the increased staffing we are putting into place, so funding has been put in place for that,” Steans said.

According to David Vinkler, associate state director for AARP Illinois, which supports the proposal to increase the number of hours a register nurse should spend with a patient, Illinois is in the top five states for the number of bed sores cases for high risk patients and No. 24 for quality of life and quality care. He said registered nurses are vital to the nursing patients. “They [registered nurses] are the only ones who can assess the patient and adjust their care. They can make changes quickly,” said Vinkler. “We all have heard the stories about abuse and neglect in nursing homes. We need a change, I think at the end of the day, the fact that Illinois nursing homes don’t have enough RNs' staff is ridiculous.”

Some members of JCAR say they support the higher RN staffing levels. “I intend to vote in favor,” said Rep. Gregory Harris, a Democrat from Chicago who serves on the JCAR committee. “I believe this is the right thing to do in public policy. We as lawmakers have to advocate for those who are not able to advocate for themselves.”

Harris said the 20 percent requirement is what the bill sponsors wanted, but not all committee members are sure about tomorrow’s outcome. “I have some real concerns about the rule,” said Sen. Dale Righter, a Republican from Mattoon, who also serves on JCAR. Righter says he will weigh what both sides have to say Tuesday.

The JCAR hearing is scheduled for 9:30 a.m.