The health care industry avoided a headache this past weekend amid the budget battle when one bill that could have significant impact on the nursing home industry stalled after clearing the Senate.
Initially, the bill, which would establish a certified nursing assistant (CNA) to patient ratio at nursing homes, looked as if it would pass before the summer was over, but the issue is now likely to be taken up in the fall.
Supporters of the bill, mainly from the unions, believe more nurses are needed, as well as more hours to care for a patient or resident at a time.
Critics, including the New Jersey Hospital Association and New Jersey Business & Industry Association, say the ratio is an artificial mandate because it ignores the reality: There is a shortage of available CNAs.
“An arbitrary ratio is not going to make them magically appear,” NJHA spokeswoman Kerry McKean Kelly said.
The Department of Labor reports that there have been 4,053 job postings for nursing assistants in New Jersey between June 2017 and May 2018, and many of those postings were for multiple positions in a single company.
There are currently more than 1,800 positions available, and the bill would require posting an additional 2,500 openings — a total of 4,300 positions that would need to be filled in the state.
NJHA has a better bill in mind: The way to find more nurses to fill the already available positions is to ensure reciprocity for licenses.
If a nurse is registered in a neighboring state and lives close to the border, he or she is currently not allowed to practice in New Jersey. If that changed, it could result in an increase in the labor supply pool.
Even incentives such as referral fees and signing bonuses that range from several hundred to a couple thousand dollars haven’t moved the needle.
Opponents say another problem with a ratio bill is the cost burden on the nursing homes and overlooking the current trend of team care that is growing in the health care industry.
The latter would be an easy fix in the bill — simply include other staffers involved in the care of a resident as part of the ratio tally, rather than focus on nursing assitants alone, according to Theresa Edelstein, vice president of post-acute policy at NJHA.
“To impose a ratio on a facility who is trying to staff according to the needs of their residents is really counterproductive,” she said. “We’d like to see (other staff members) counted in the ratios.”
The overall cost, based on current data, is $95 million in additional expense for the industry.
That’s hard for the industry, which relies largely on the low-paying source of Medicaid. Most rely at least 60 percent on Medicaid for their revenue, Edelstein said.
As it stands, if the ratio were to go into effect, many of New Jersey’s nursing homes would be in violation and unable to solve that problem quickly.
The bill, sponsored by Sens. Vin Gopal (D-Ocean Twp.) and Brian Stack (D-Jersey City), passed the Senate this week.
“New Jersey was ranked 43 out of 50 in direct care staffing hours per nursing home resident by the national nursing home watch dog organization, Families for Better Care. They gave us a solid ‘F’,” Gopal said.
“These are our parents and grandparents. And, soon, they will be us. We have to do better for our senior citizens and the frail and elderly of our state.”
If it passes, the bill authorizes the commissioner of health to set the standards, including any required reporting and mechanisms of enforcement.