Del. Bobby Orrock Sr., R-Caroline, introduced House Bill 1446, which would establish minimum staffing requirements for certified nursing facilities. A nursing facility, which includes nursing homes, provides health-related services on an ongoing basis in accordance with state code.
The measure passed the House by a near unanimous vote of 95–2 and was placed in a finance committee after passing unanimously in a Senate health committee.
“Ultimately, I think it will be a step forward in the quality of patient care,” said Orrock.
Del. Vivian Watts, D-Fairfax, introduced HB 1564, which would have established regulations for minimum staffing and standards of care in nursing homes. The bill was never heard in committee and is dead for session.
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Decreased supply and increased demand for nursing staff has contributed to the largest shortage of nursing staff in the United States, according to a Nurse Journal article. The COVID-19 pandemic has widened the gap between supply and demand, and shortages are expected to worsen in 2023.
Eighty-six percent of nursing home and assisted living facility staff surveyed by the Virginia Heath Care Association and the Virginia Center for Assisted Living reported a “worse overall workforce situation” in 2022 compared to 2020. 5 percentage points higher than the answers given to the same question in 2021.
VHCA-VCAL is Virginia’s largest association that advocates for long-term care providers. Only 3% of respondents reported a full staff and 16% reported a “crisis” with numerous shift openings but few qualified candidates. Many critical roles go unfilled due to vacancies, the VHCA-VCAL reported.
The national average daily hours per resident is 3 hours and 45 minutes, and the state average is 3 hours and 35 minutes, according to Medicare. More staff hours per resident per day is better, according to Medicare.
Watt’s bill would set the minimum call hours per resident at 3.5 hours by 2027 and gradually increase to 4.1 hours by 2033.
“You really can’t provide quality care when you’re short,” said Denise Davis, who has worked in healthcare for 20 years and is a contract nurse at Lakeside Health & Rehabilitation Center, a nursing home in Richmond. “It’s just the bare minimum.”
The total number of daily hours per resident at the center where Davis works is just under three hours, according to Medicare. The center serves an average of 166 residents per day, according to the same Medicare profile. The national average of nursing home residents per day is nearly 79 and the state average is 92 nursing home residents per day.
The top three reasons for the overall loss of staff since the start of the COVID-19 pandemic are burnout, contract or travel work, and complete abandonment of the healthcare industry, according to the VHCA-VCAL.
Davis often works double shifts and is called upon to cover the team’s regular shifts, she said. Nearly all facilities that responded to the VHCA-VCAL survey need staff to work extra hours or work extra shifts. The facilities still rely heavily on outside personnel, according to the VHCA-VCAL.
Despite active recruitment, 93% of facilities have openings for certified licensed practical nurses, or CNAs, and 87% have openings for higher-paid, licensed practical nurses, according to the VHCA-VCAL.
Long-term care providers are not well paid and there is competition for similar opportunities or higher salaries, Del said. Dawn Adams, D-Richmond, in an email. Adams is a nurse and co-patron of the Orrock account.
“Finding individuals to provide care in an area that is often physically and emotionally demanding remains a challenge,” said Adams.
There are different types and levels of staffing in nursing facilities. This includes agency nurses who hire out to work in different nursing facilities. Travel nurses have similar contracts and travel to different facilities to work. There are also training nursing assistants, or TNAs, who assist nurses and CNAs but are not certified or licensed as CNAs.
Asia Jones, TNA at Lakeside Health & Rehabilitation Center, said she has an increased workload due to staff shortages. Jones’ duties as a TNA include taking vitals, feeding and changing patients.
“We shouldn’t really physically touch patients … or take over entire floors [of patients] for ourselves,” Jones said of his experience.
She doesn’t feel adequately trained to work to become certified, she said.
“They kind of threw me in the ground the first day and just told me to go with the other CNAs,” Jones said.
Both bills proposed minimum standards for the qualification and training of nursing staff in nursing homes, hospitals and certified nursing facilities, with the exception of staff licensed or certified by the Department of Health Professions.
Watts proposed minimum standards in nursing facilities starting 20 years ago, she said.
“I look at these people in our nursing homes and they’re not just old people … to just be ignored, to be thrown away,” Watts said.
Lack of advocacy and cost are the reasons the bills failed to pass, Watts said.
Pressure on healthcare staff due to the COVID-19 pandemic has highlighted conditions in nursing homes, Watts said. Staffing shortages also make it difficult to meet minimum standards, she said.
It’s not safe for patients to have an inadequate staff-patient relationship and it overwhelms staff with patients, said Nurse Ashley Apple, commissioner of government relations for the Association of Nurses of Virginia and assistant professor of nursing at the University of Virginia. .
The VNA is an advocacy group representing more than 100,000 nurses and works to advance professional practice and encourage the delivery of quality care, according to its website. The organization’s advocacy work focuses more on hospital settings than nursing homes.
The healthcare industry will continue to “bleed healthcare professionals” if lawmakers don’t realize that workplace protections are necessary for employee and patient safety, Apple said. Health workers are saddled with more work than they can handle, she said.
“There aren’t enough minutes in the day to provide the level of care they want,” Apple said. “It’s morally distressing for healthcare professionals.”
Capital News Service is a program at the Robertson School of Media and Culture at Virginia Commonwealth University. Students in the program provide state government coverage for a variety of media outlets in Virginia.