[Congressional Record Volume 147, Number 51 (Monday, April 23, 2001)]
[Senate]
[Pages S3782-S3783]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                NURSING SERVICES QUALITY IMPROVEMENT ACT

  Mr. DORGAN. Mr. President, on April 6 my colleagues and I introduced 
the Medicare and Medicaid Nursing Services Quality Improvement Act of 
2001. This legislation is intended to help address a problem currently 
facing nursing homes in North Dakota and Wisconsin and potentially 
other nursing homes across the country.
  We all know that nursing homes nationwide are facing a looming 
staffing crisis that is expected to worsen as the baby boomers reach 
retirement. An American Health Care Association report, entitled 
``Staffing of Nursing Services in Long Term Care,'' estimates that the 
need for registered nurses will grow 66 percent between 1991 and 2020 
and the number of licensed practical nurses needed will grow by nearly 
72 percent over the same time. Likewise, the number of nurse aides who 
will be necessary is projected to grow by 69 percent.
  In my State, nursing home administrators have a thousand open nurse 
aide positions that they have been unable to fill. A number of nursing 
home administrators in North Dakota have told me that they have had to 
refuse patients because they do not have adequate staff to care for 
them.
  Unfortunately, a problem has arisen in my State that will exacerbate 
this staffing shortage. By way of background, North Dakota nursing 
homes have been using trained resident assistants --called feeding 
assistants in North Dakota,--to help feed nursing home patients. This 
has been the practice for the last decade with positive results. The 
data in North Dakota indicates that our nursing home patients 
experience less weight loss and dehydration than patients nationally, 
and nursing home officials in North Dakota attribute this to the use of 
resident assistants.
  The problem, however, is that the Health Care Financing 
Administration has told North Dakota and other nursing homes that they 
can no longer continue to use these trained resident assistants because 
they lack certification. In North Dakota, this means that hundreds of 
resident assistants may need to be laid off later this year, even while 
my State's nursing homes are experiencing difficulty finding certified 
staff.
  The bill that I introduced along with Senators Kohl and Conrad would 
allow

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North Dakota and Wisconsin to continue using resident assistants for 
feeding and hydration, while a demonstration project is conducted in 
our states and others to evaluate what kind of impact the use of these 
staff has on the quality of feeding and hydration services provided to 
nursing home patients and on the recruitment and retention of nursing 
staff. If after the three-year demonstration project, the Secretary of 
Health and Human Services determines that the use of resident 
assistants does not result in a reduction in the quality of feeding and 
hydrating of nursing home residents or in a decrease in the recruitment 
and retention of nursing staff, other nursing homes around the country 
would be allowed to use resident assistants to help with feeding and 
hydration tasks.
  This legislation includes a number of safeguards designed to protect 
nursing home patients. For instance, nursing homes are prohibited from 
using resident assistants to replace existing nursing staff or to count 
these assistants toward minimum nursing staffing requirements. In 
addition, resident assistants would have to complete a state-approved 
training program related to the feeding and hydration tasks they would 
be performing. Of course, nursing homes would not be able to use 
resident assistants to administer medication, provide direct medical 
care, or perform other nursing tasks.
  I recognize that this bill is not the only answer or the whole answer 
for addressing the staffing crisis in nursing homes. I want to work 
with my colleagues in Congress, nursing homes, and advocates for 
nursing home residents to address this larger issue of the staffing 
shortage.
  The staffing shortage in nursing homes is not the only reason for 
malnutrition and dehydration of patients, but it certainly contributes 
to the problem. A June, 2000 Commonwealth Fund study estimated that 35 
to 85 percent of nursing home patients are malnourished, in part 
because they do not receive enough assistance from aides while eating 
because the aides must assist as many as 15 to 20 patients at mealtime. 
According to a Los Angeles Times article earlier this week, a 
University of California-San Francisco professor who observed 100 
nursing home residents with eating problems found that nursing home 
workers were often so rushed that they ``shoveled'' food into their 
patients' mouths, causing choking and coughing.
  The resident assistants in North Dakota provide compassionate care 
and often have more time to coax their patients into eating, something 
that overworked certified nurse aides generally don't have time for. I 
am convinced that if we reduce the number of staff in North Dakota 
nursing homes, which is what will happen if long-term care facilities 
can no longer use resident assistants, then patients in North Dakota 
will suffer.
  One resident assistant in North Dakota told me about a patient she 
feeds who has difficulty holding her head up when she eats. The 
resident assistant said that when she was on vacation, her patient lost 
seven pounds. Fortunately, after a few weeks back on the job, the 
resident assistant got her patient's weight back up to where it needed 
to be. However, if this resident assistant was forced to leave her post 
permanently, that weight loss may have been long-term and ultimately 
life-threatening.
  I believe the Medicare and Medicaid Nursing Services Quality 
Improvement Act is a step that Congress can take to address both the 
staffing shortage and the malnutrition of patients. This is not the 
only solution and it may not be the best solution, but I hope my 
colleagues will work with Senator Kohl, Senator Conrad and me to tackle 
these serious issues confronting long-term care facilities and their 
patients.

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