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Op-Ed on increasing direct care hours at PA Nursing Homes
By Lamont McClure
Recently, the Wolf administration proposed increasing the minimum of direct care hours at skilled nursing homes by 1.4 hours Per Patient Day (or PPD), increasing the current 2.7 PPD standard to 4.1 PPD within a 24-hour period. Governor Wolf’s intentions are good—revising nursing home regulations to improve care for residents and working conditions for staff is important—but the increase is not realistic at this time. Not without addressing the nationwide-staffing problem or the chronic underfunding of Long Term Care (LTC) facilities
The County of Northampton has the honor and the responsibility of running the largest LTC facility under one roof in the Commonwealth of Pennsylvania—Gracedale Nursing Home. Over the last decade hiring in the healthcare field, especially for facilities like Gracedale, has been challenging. With 688 licensed beds, our staffing needs are greater than most nursing homes.
Northampton County offers a general benefits package which includes ample paid time off, a good salary, educational opportunities and job advancement. We also provide our staff an incentive that is hard to find today—a defined benefit pension plan with the opportunity to retire at age 55.
Over the past few years, our Human Resources department has been especially aggressive in its effort to hire new staff. We’ve increased our marketing budget, vastly expanded our advertisements and offered a referral bonus to current employees. We did all this with the goal of getting more employees in the door to care for our residents. Then, in 2020, we were hit with an once-in-a-lifetime pandemic and COVID-19 sent our already fragile environment into a tailspin. Nursing homes across the nation faced the fight of their lives against an unseen force. Healthcare no longer seemed like an appealing career path. Some employees re-evaluated their careers, others chose early retirement or quit leaving us to scramble to fill the vacancies they left behind.
Gracedale has always strived to hover around 3.4 PPD, but now we struggle to make 2.7 and we are not alone. Many nursing homes are laboring to meet the 2.7 benchmark. Some have come to depend on Agency nurses, but the agencies are having a tough time finding enough employees themselves. Unless the Commonwealth is willing to look at assistance in the recruitment efforts for LTCs, I do not see how we can get to and maintain 4.1 hours of care per day.
As I previously stated, Gracedale is a 688 bed skilled nursing facility. Currently, we have a census of 432 and most of our residents are on Medicaid. We are paid roughly $220 per Resident per day through Community HealthChoices, the new managed Medicaid system in the Commonwealth. The cost to care for Medicaid residents is roughly $339 per day. Gracedale has a waiting list for new residents, but can’t increase its census until we increase our staffing.
As a County-owned-and-operated facility, we are stewards of the taxpayers of Northampton County and, as such, we need to be fiscally responsible while caring for our residents. As a County home, we are reimbursed at a lower rate for Medicaid than private operators. If we are required to obtain a 4.1 PPD, we will face financial ruin.
If the Commonwealth proceeds with this proposal to raise the ramifications will cut deep. With almost every LTC facility in Pennsylvania not being able to obtain the staffing levels required the Department of Health (DOH) will cite deficiencies. With that will come poor ratings, crushing resident referrals and adding civil money penalties to the financial burden of caring for our most vulnerable citizens. Continued non-compliance means provisional licenses and potential forced closures.
As a County-nursing home, Gracedale is sometimes the first choice when care is needed but, most often, we are peoples’ last and only chance at survival. Most nursing homes are not willing to admit the category of residents we care for. We admit based on need, not on income. Where would our current residents and future residents go if there is no Gracedale? Private facilities look at them as liabilities, categorizing them as ‘non-revenue generating.’ Without Gracedale our most vulnerable residents may be sent to shelters which aren’t equipped to care for them or, in a worst case scenario, they may join the homeless population. The Commonwealth must consider these outcomes when it comes to increasing the rate to 4.1 PPD. We are humbly requesting that, at least for now, the Commonwealth keep the PPD for publicly run nursing homes at 2.7 through 2023. As the situation on the ground with COVID-19, and the economy improves, I respectfully ask that PPD be raised to 3.4 by the end of 2024, and then finally 4.1 by 2025. That should give us sufficient breathing room.
Information provided to TVL by:
Becky Bartlett
Deputy Director of Administration
Northampton County Government Center
669 Washington Street
Easton, PA 18042
https://www.northamptoncounty.org/
