- cross-posted to:
- politics@sh.itjust.works
- cross-posted to:
- politics@sh.itjust.works
The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes, Vice President Kamala Harris announced.
The controversial mandate requires that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift, according to a White House fact sheet.
Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in, with rural communities having longer timeframes, and temporary exemptions will be available for facilities in areas with workforce shortages that demonstrate a good faith effort to hire.
The rule, which was first proposed in September and initially called for at least three hours of daily nursing care per resident, is aimed at addressing nursing homes that are chronically understaffed, which can lead to sub-standard or unsafe care, the White House said.
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It’s not controversial if only monied interests say so.
Good for the admin though keep pushing.
I often go to nursing homes for medical calls, and asking for basic patient information is always a treat at the crappier ones.
Pro-tip: when the medic asks you things like “What are we here for?”, “How long have they been having this issue?”, or “What’s their medical history?” you don’t actually have to answer. Just give a blank stare and say “I don’t know, I just started my shift” or “They’re not my patient”. All you have to do is give the ambulance crew the patient’s name and birthday, and even that’s optional.
Is the patient dead and you don’t know when it happened? Say “I was talking to them a few minutes ago!” even if they’re cold to the touch. Bonus points if the pt has a DNR and you don’t give it to the medic.
If all that is too much work, say “I’ll go check” and find somewhere to hide until they leave with the patient – this situation is their problem now.
I work in 911 dispatch, nursing homes are one of the banes of my existence.
Do they have any medical history we should know about?
No.
Oh, I guess they’re just putting perfectly healthy 57 year olds in nursing homes now, good to know.Half of them can’t tell me the address of the damn place they work, which is really nice when they call from their cell phone which barely gets any signal inside the building. Sometimes it’s a crapshoot if they can even tell me the name of the facility
For whole lot of the people who work there, at least at the homes around me, English isn’t their first language, and they don’t speak or understand it very well and speak with a very heavy accent. I’m not knocking them just for that though, they speak more languages than I do, and are clearly trying to make a better life for themselves, I certainly can’t fault them for that, but it does make me a little concerned for their patients. If I, as someone with all of my mental faculties and hearing intact, can barely communicate with you, how effectively can they be treating and supporting patients who often have significant cognitive and/or hearing impairments?
Don’t get me started on the med techs. I’m not any kind of a healthcare professional, so I have only the vaguest idea what their role actually is in a nursing home, but from when they call 911 you would get the impression that they’re kept in a dark soundproof closet until they need someone to call 911, then they’re abruptly yanked out of the closet, spun around a few times, hit over the head with the phone, and told to call 911 while a strobe light flashes in their face, because they never have any idea what’s going on
Now don’t get me wrong, some nursing home staff are great, they have all of the information ready when they call, they’re polite, professional, everything I could hope for, but unfortunately they’re kind of the exception. 90% of the time when I see a call coming in from a nursing home I need to brace myself to deal with someone who is just an absolute mess, disorganized, ill-prepared, unintelligible, uncooperative, sometimes outright rude. Sometimes I consider myself lucky if they don’t just outright hang up on me halfway through the call.
Also some of them love medical jargon, and as I said I’m not a medical professional. They’ll call, rattle off a bunch of stats and vitals that mean nothing to me and aren’t going in my notes even if I could type as fast as they’re spitting them out. When I try to determine what the chief complaint is they’ll spit out something like “their potassium is low,” forcing me to ask for further clarification in plain english, so I know whether to code it as a cardiac thing, a respiratory thing, etc.
Your comment about people who don’t speak English fluently reminded me to take a moment to appreciate that there are a non-zero number of asshole racists who, by nature of being cared for by (at least in some circumstances) people of varied races, do indeed die mad.
That makes me think of my own grandfather (in a good way) I will never claim that he was the most forward-thinking, tolerant, or politically correct person out there, there were a few stereotypes and bits out outdated terminology he never quite shook (for example, the term “colored” never quite left his vocabulary, and he had a tiny bit of lingering distrust of the Japanese having served in the Pacific during WWII)
But for a man who grew up in the time he did, he wasn’t half-bad.
He was never someone who was above holding a a grudge, and he’d gladly tell anyone who would listen who he didn’t like and why. His reasons weren’t always good, he got mad at people over a lot of petty bullshit, but I never heard him disparage someone because of their race. He ended up in a nursing home where a lot of the staff was black, and we never heard a peep from him about their race, he found plenty of other things to complain about, but there was no racial bias to it, he complained about the white employees as much or more than the black ones.
Little bit of fun family history with him, for most of his life he worked as a bus driver. Buses in our part of the country were racially integrated from pretty early on so that was never something he dealt with directly, but he did drive his bus at the same time that bus boycotts and such would have been happening in other parts of the country. He never told us this story himself, we heard it from some other older locals who remembered him driving the bus. There was one particular bus stop that was near a business that employed a lot of black women, and many of them took the bus. The bus would come at around the same time the business closed for the night, so they didn’t have much time to get to the stop before the bus came. A lot of other drivers wouldn’t wait for them, but my grandfather always did, and decades later many of them still remembered him for that.
These are great tips. Can we adapt them to other industries? Maintaining information directly related to your employment is just so difficult and inconvenient at times.
They shouldn’t give exceptions for “good faith effort to hire.” If you can’t hire someone, clearly you aren’t matching what the market demands and need to improve working conditions and pay.
Just like “emergency certifications” in teaching, when the solution to “we don’t have enough qualified people” becomes letting any one with a pulse in, we end up with a race to the bottoms in employee qualifications, pay and working conditions.
You cannot expect someone go through years of school, with additional specialized training, sometimes even masters or doctoral level degrees, to work for substandard wages. In the medical field especially - the mobile and qualified can make bank as travel nurses, why would they bother with you?
If there are too many patients, can that Texas politician’s grandma give up her life for the economy?
(99% positive the politician was from Texas. Pretty this statement wasn’t from Ted Cruz, but maybe. During COVID saying that grandmas in nursing homes would give up their life to open up lockdowns to restore the economy.)
You are thinking of Dan Patrick, he is the Lt. Governor making him the 2nd biggest cunt in Texas right behind Abbot but ahead of Paxton and Cruz. Though, one could argue that the biggest piece of shit stuck to the bottom of Texas’s shoe is Paxton I prefer to lump all 4 in the same bag of dicks.
Thanks.
Yeah, they are just different faces of the same evil.
Isnt a big reason the rail workers had such shitty schedules us because they are understaffed as well?
Correct. They need to strike a hell of a lot harder, and Biden needs to back the union harder. The owners of the rail companies are selfish greedy pigs.
I worked on skilled nursing facilities insurance during the pandemic. Mostly a horror show by owners who don’t GAF about your grandpa and would rather spend money on their personal vehicles than invest in adequate staffing and maintenance. Disgusting group of people.
I’m curious how they came up with 3.48 hours. Does rounding it up to 3.5 really make that much of a difference?
They’re probably working with larger numbers of hours, like in terms of years, and compromises then lower the numbers that later get divided back down into fractional hours.
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At first I was like “wait, how is this controversial?”
FTA:
“Nursing home operators strongly objected to the minimum staffing proposal in September, saying they already struggle to fill open positions. Such a requirement could force some facilities to close.”
There are two options for a nursing home in this position:
- Hire more people.
- Reduce the number of patients.
But here’s the damned part of it… if they shed patients, or just flat out close up shop, all those patients have to go SOMEWHERE and now that’s going to stress OTHER facilities who will need to… yup… hire more or reduce the number of patients.
FTA:
“a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift”
Has anyone done the boomer math here?
https://acl.gov/ltc/basic-needs/how-much-care-will-you-need
"Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years
Women need care longer (3.7 years) than men (2.2 years)
One-third of today’s 65 year-olds may never need long-term care support, but 20 percent will need it for longer than 5 years"
Woof. 76.4 million boomers.
https://www.prb.org/resources/just-how-many-baby-boomers-are-there/
2-3% of that for registered nurses.
10-11% for nurse aides.
2% additional nurse staff.So as much as 15% of the population needed just for nursing staff?
70% of 76.4 million = 53,480,000 boomers needing nursing home care.
15% of 53,480,000 = 8,022,000 nursing staff needed, JUST for the nursing homes.
https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet
“Nursing is the nation’s largest healthcare profession, with nearly 4.7 million registered nurses (RNs) nationwide. Of all licensed RNs, 89% are employed in nursing.”
Now that’s just RNs and we only need 2-3% for RNs, but that is still 1,604,400 just dedicated to nursing homes, or about 1/4 of all nurses.
“This statistic shows the number of persons employed in U.S. nursing care facilities from 2000 to 2022. In 2022, there were approximately 1,280,000 persons employed in nursing care facilities all over the United State, a significant decrease compared to previous years.”
Note, that figure is a fraction of what would be needed and that’s ALL nursing home staff, not just the nurses.
This is a great IDEA, and nobody wants nursing home residents living in squalor, but I just don’t see how that mandate is achievable… unless someone puts Boston Dynamics robots through nursing schol…
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Pay higher wages
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Improve working conditions
The reason they struggle to fill these positions is because of how terrible they treat their front-line staff
That AND there aren’t enough qualified people in the pipeline to fill all the positions that need to be filled.
Labor shortages are always, always, caused by compensation problems or management problems. Every single time. No exceptions.
There are plenty of ex nurses that left the profession during covid. It became abundantly clear how little they were respected. Try respecting them again and maybe you won’t have shortages.
You know the best way to show respect? Proper compensation and competent management.
A nursing program is 16 months. Even if they miraculously started paying more today, the next crop of students isn’t going to see it for almost a year and a half.
That’s the other part of it. You have to attract people to a 16 month commitment before they ever see a salary and there aren’t enough people currently in that pipe at any pay level.
And? Are you claiming if something can’t be fixed tomorrow it’s not worth working on?
No, I’m saying the problem is larger than “well, pay them more.”
No I don’t think it is. It’s just not an instant fix. But nothing in life ever is so that’s a silly way to go about thinking of the world. Besides, there’s nothing to say it would even take years to correct. There’s plenty of nurses that got out of the game due to lack of pay and lack of proper management. Not only would new people get into the profession, but many would come back.
Certainly I think it’s a better solution than continually to underpay them and hoping it’ll work itself out. A pizza party ain’t going to save this shit. There’s no magical scenario to fix underemployment in an industry that doesn’t involve proper compensation.
If they paid enough, there would be more workers entering the pipeline
For 16 months from now, sure. That doesn’t change anything in the interim.
Welp, I guess we’ll just give up then.
Good thing the article stated this doesn’t go into effect immediately.
Raise wages and more people will join the pipeline.
Yes, paying people appropriately really is a silver bullet.
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Your math is… Difficult to follow, to say the least.
tl;dr We need nurse robots!
15% of 53,480,000 = 8,022,000 nursing staff needed, JUST for the nursing homes.
It seems you’re making the assumption that all these baby boomers will need care in a nursing home at the same time. This doesn’t seem reasonable at all given there’s an 18 year age range among boomers.
Granted it’s not going to happen all at the same time, but when the oldest ones have died off, the oldest GenX’ers (me) will start qualifying.
Regardless if the number is 8 million nurses, 1 million nurses, or something in between, we don’t have enough people working the jobs or in the pipeline to meet this mandate.
