New York Lawmakers Mandate Minimum Staffing for Nursing Homes, Hospitals

The New York State Legislature approved measures that will require hospitals and nursing homes to meet minimum staffing levels of nurses and other health care staff.

Measures mandating minimum staffing at health care facilities have been around for several years, but the spotlight on stressed and understaffed hospitals and nursing homes during the COVID-19 pandemic finally prompted the bill’s passage.

Senate sponsor and Health Committee chair Gustavo Rivera spoke before the vote.

“This is an historic moment,” said Rivera, who added that in the decade he’s held office, he’s had more meetings on the topic than any other issue.

The measures provide different approaches to hospitals and nursing homes.

The state health commissioner would establish minimum staffing levels for nursing homes and would impose civil penalties if the homes fail to meet the minimum standards. Each resident would receive an average of 3.5 hours of care a day, with at least one hour from registered or licensed practical nurses and two hours from certified nursing assistants.

The new rules would take effect in January.

The measure comes after a provision in the state budget that requires nursing homes to spend 70% of their revenue on direct patient care.

The bill that regulates hospital workers sets up clinical staffing committees in hospitals to determine staffing guidelines and decide the proper ratio between patients and staff. The panels would include hospital administrators as well as registered nurses, licensed practical nurses, and other staff members who provide direct patient care.

The legislation is backed by health care unions, including the New York State Nurses Association and 1199 SEIU.

Nurses union treasurer Nancy Hagans said the measures are a “good start."

“Finally, we could have a strong law and tools we need to advocate for our patients,” Hagans said.

Rudy Sokna, a registered nurse and SEIU union member who works in a nursing home, said even before the pandemic, it was understaffed. And he said the pressure mounted when COVID-19 struck. He said he never had enough time to talk to family members who wanted to know how their loved ones were faring, when many were ill and dying.

“It’s like seeing your own family members dying in front of you,” said Sokna, who added he was often the only one there with residents in their final hours. “I felt helpless.”

The measure is also backed by the state’s major hospital lobbying groups, the Greater New York Hospital Association and the Healthcare Association of New York State.

HANYS President Bea Grause said the addition of the staffing committees gives hospitals “flexibility” in making staffing choices.

But some nursing home owners said it could be difficult for them to meet the new standards. Michael Balboni, executive director of the Greater New York Health Care Facilities Association, a nonprofit trade organization representing downstate nursing homes, said nursing homes have struggled for decades to find enough trained staff. He said the state has not done enough to help recruit and retain nursing home staff.

“We haven’t done anything to develop the workforce,” Balboni said. “And this has been an issue way before the pandemic.”

And he said many nurses are leaving the profession after a long and difficult year.

Balboni said state lawmakers cut Medicaid reimbursement rates that pay the costs of caring for many of the residents. At the same time, costs rose for personal protective equipment and other items needed to meet COVID-19 protocols.

The disease took a tremendous toll on nursing home residents and staff; 15,000 residents died in the homes and other long-term care facilities. Cuomo and his staff’s handling of the death toll is the subject of a federal investigation, and a January report by state Attorney General Tish James was critical of many nursing home practices.

Balboni said some nursing homes might have to close if they have to meet the new standards, and he said the approach should be collaborative to find a solution, not punitive.

“We should learn the lessons from this horrible time, and we should institutionalize the things that worked, and we should jettison the things that didn’t,” Balboni said. “This legislation is driven by the union, and it’s been very successful, but it’s not necessarily going to affect outcomes.” 

Rivera said he believes the nursing homes will be able to cope with the new staffing standards and survive.

The bills now go to the governor’s desk to sign or veto. A spokesman for Cuomo was noncommittal, saying the measures are “under review.”