Put more RNs in nursing homes
In February, Illinois Rep. Jan Schakowsky re-introduced into Congress the Put a Registered Nurse in the Nursing Home Act (H.R. 952), which would require skilled care nursing homes that receive Medicare and/or Medicaid reimbursement to have a direct-care Registered Nurse (RN) on duty 24 hours per day, 7 days per week. Currently nursing homes are only required to have one direct-care Registered Nurse present in a facility for 8 out of 24 hours regardless of the size.
At this time there are 11 members of Congress, from eight states, co-sponsoring the bill but none from South Carolina. I spoke with a staffer in Rep. Schakowsky’s office who related how they hear many horror stories about what is going on in nursing homes. I personally experience much dismay when I visit nursing homes. I may be present as a visitor but I see through the lens of a former long-term care employee and educator in long term care curricula. I wonder how much of what I see could be averted if there were RNs present, making the clinical judgment decisions.
In June the South Carolina Institute of Medicine and Public Health (IMPH) issued a guide for Improving Long-Term Care in South Carolina. The guide includes 30 recommendations to assist in reevaluating our current policies in S.C. Recommendation 13 is under the heading of Ensuring an Adequate and Trained Workforce stating, “Enable registered nurses to delegate specific nursing tasks to unlicensed direct-care workers with sufficient training and demonstrated competencies, subject to consumer protections.”
Recommendation 13 is to no avail until Recommendation 9 is clarified. Recommendation 9 states, “Increase the presence and capacity of nurses in the long-term care workforce.” Does this mean to imply the professional RN or the technical Licensed Practical Nurse (LPN)?
If we already see workforce trends in nursing homes sufficient to generate the Congressional Bill H.R. 952, why move to further dilute the RN presence in facilities. Since we now require only a one RN for 8 out of 24 hours you can be assured much delegation of professional duties is already taking place. More RNs present should equate to less delegation being needed.
Perhaps the IMPH should pull back on Recommendation 13 until we first get federal regulations requiring RNs to be present 24/7 in skilled care facilities. Continuous direct-care RN staffing is necessary. The owners and budget planners in the long term care industry will no doubt jump on Recommendation 13. South Carolina policymakers who look to IMPH for information may want to research a little deeper.
Should Recommendation 13 get traction to inform S.C. policies our skilled care facilities will become no more than warehouses for older persons who cannot private pay for better facilities. Even with the current level of RN delegation of professional task to unlicensed persons, many of the unlicensed direct-care staff question if they should be paid more for doing the delegated task. Also, since the RN who delegates professional task assumes liability for task they delegate the RN applicants for jobs in skilled care nursing homes may decline.
Without a strong RN presence the warehouse quality of long-term care will become the norm for Medicare/Medicaid residents. The owners of such facilities are always looking for ways to maximize profits. The ride down the slippery slope may invite a moral decadence we never imagined. After all this is the age of resource allocation. Meals for residents can be allocated or rationed to save money as well as diapers and other supplies. Expensive medications could be reevaluated.
Contact your representative and request support for Congressional Bill H.R. 952, Put a Registered Nurse in the Nursing Home Act.
Dr. Sybil Smith is semi-retired from a career in nursing and education and resides in Lyman. She can be reached at smithgroup@charter.net.