[Congressional Record Volume 146, Number 150 (Thursday, December 7, 2000)]
[Extensions of Remarks]
[Pages E2139-E2140]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 INTRODUCTION OF THE NURSING FACILITY STAFFING IMPROVEMENT ACT OF 2000

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Thursday, December 7, 2000

  Mr. STARK. Mr. Speaker, I am pleased today to introduce legislation 
with Representative Henry Waxman  that focuses clear attention on the 
critical role that staffing plays in delivering quality care to the 1.6 
million people--our parents, grandparents, siblings and spouses--whose 
fragile health requires them to live in nursing homes.
  Policymakers and the public have heard stories for years about the 
high cost of poor care. And most of us intuitively know that 
understaffing is a causal or contributing factor in the hundreds of sad 
tales of neglect and abuse that are identified and publicized each 
year.
  The impetus for this legislation is both a recent HHS report on 
nursing facility staffing ratios and a local study conducted in my 
district that highlights the correlation between quality of care and 
staffing levels.
  The ``Nursing Facility Staffing Improvement Act of 2000'' proposed a 
remedy for chronic understaffing in nursing homes: It directs state 
surveyors to conduct special staffing assessments in instances where 
they identify quality of care deficiencies that either cause actual 
harm, or that pose a risk of immediate jeopardy to resident health or 
safety.
  If there is a finding that inadequate staffing has contributed to an 
actual harm or immediate jeopardy deficiency, the bill requires those 
facilities to submit corrective action plans within 30 days stipulating 
the number and type of additional nursing staff necessary to assure 
resident well-being. Facilities would then face tough scrutiny from 
state inspectors, who would check and enforce continued compliance 
during two interim staffing-only surveys that would occur before the 
next routine annual inspection. In the event that a facility was again 
found to have inadequate staffing during an interim survey, an 
additional two years of interim staffing surveys from that date forward 
would be triggered.
  As a separate disclosure requirement, the HHS Secretary would make 
facility-specific staffing data available on the ``Nursing Home 
Compare'' website. The data, which would include total hours of care 
provided per shift by both licensed and unlicensed nursing staff could 
be reviewed by family members before placing their loved ones in a 
facility and aid them in making informed choices.
  The legislation does not propose any new fines or penalties for 
inadequate staffing. Rather, it holds nursing homes responsible for 
providing consistently adequate levels of nurse staffing, which all 
experts tell us is the foundation of good medical and supportive care 
for medically complex, fragile people. It accomplishes this through a 
system of stepped-up scrutiny and public accountability.
  The remedy we are proposing today will improve enforcement of those 
staffing standards that currently apply, as well as standards that are 
developed in the future.
  This legislation will strengthen our federal oversight system. Under 
current law, many inspectors find it relatively difficult to document 
and defend appeals of citations of facility understaffing. This bill 
would change that by directing surveyors to analyze the role that 
staffing plays whenever there are serious quality deficiencies. And if 
will serve as a wake-up call for those facilities they try to control 
expenses by cutting back on the number and wages of nursing staff.
  Last July, phase one of an important HHS staffing study, titled 
``Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes'' 
was released. It is an important analysis for many reasons, and the 
first federal study of its kind. Its central findings is that most 
facilities are failing to staff at levels that guarantee good care.
  In brief, HHS identified two levels of staffing--a ``preferred 
minimum'' staffing levels of 3.45 hours of nursing care for each 
resident each day, with 2 hours of this care providing by nursing 
assistants, 1 hour by a registered or licensed nurse, and 0.45 hours 
only by registered nurses. Quality of care in facilities that staffed 
above this level, the study concluded, was ``improved across the 
board.''
  HHS also identified a lower ``minimum'' level of 2.95 hours of 
nursing care per resident day, with 2 hours of care provided by nursing 
assistants, 0.75 by registered or licensed nurses, and 0.20 hours only 
by registered nurses. Regrettably, more than 90% of facilities in the 
U.S. fall short of this standard today.
  The agency's phase one study also shows that many states are acutely 
aware of staffing shortages in nursing facilities. Many have already 
moved to impose more stringent staffing requirements under their 
licensure authority, and some are taking up State legislation to set 
quantitative minimum staffing standards. California, for example, has a 
new law requiring all nursing facilities to provide at least 3.2 hours 
of resident care per day.
  At the federal level, we are about a year away from having national 
recommendations on a minimum ratio requirements from phase two of HHS 
staffing analysis, which will help to shape future discussions and 
debate about how to go about establishing federal staffing standards.
  The staffing shortages documented in HHS' national study are also 
reflected in many homes in my district. At my request, the Democratic 
staff of the House Government Reform Committee prepared an analysis of 
staffing levels in homes in my district. Titled ``Nursing Home Staffing 
Levels in the 13th Congressional District,'' the report shows that 86%, 
or 25 facilities, did not meet HHS' preferred minimum staffing level of 
3.45 hours of nursing care per resident day, while 55% did not meet the 
lower minimum level of 2.95 hours of nursing care.
  Equally important, this congressional study looks at the annual 
surveys of these homes during their most recent annual inspections. 
Among those facilities that did not staff at preferred minimum levels, 
68% were cited for a violation causing actual harm to residents. In 
contract, homes that did not staff at preferred minimum levels had no 
violations causing actual harm. Clearly, staffing levels matter.
  The findings of this congressional study and others like it, plus the 
implied cost of bringing nearly 16,480 nursing facilities throughout 
the country up to appropriate levels, are already the subject of 
considerable debate and discussion. In the next Congress, policymakers 
and stakeholders will begin to seriously grapple with the mechanics of 
translating HHS' future staffing recommendations into quantitative 
federal standards.

[[Page E2140]]

  In the interim, it is simply wrong to stand by and allow the current 
national epidemic of inadequate staffing to continue without 
intervention. The status quo means that nursing home residents will 
keep suffering adverse consequences in the form of poor care, or--in 
the most severe cases--neglect so profound that untimely death is the 
result.
  For all of the reasons, I urge my colleagues to join me in support of 
the ``Nursing Facility Staffing Improvement Act.'' It is a bill that I 
hope will find its way into next year's discussions on nursing home 
quality and accountability, and I invite any and all interested parties 
to comment.

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