Wolf Administration Proposes Nursing Home Regulations
Wolf Administration officials have proposed nursing home regulations focused on increasing the quality of care received by residents in skilled nursing facilities (SNFs) by increasing the minimum direct care hours. Current SNF regulations have not been updated since 1999. At the same time, the Department published a summary of its May 2021 nursing home inspections and sanctions.
Nursing home operators immediately objected to the proposals, saying the state is ignoring the financial cost to nursing homes as well as a historic shortage of workers.
“Revising nursing home regulations is one piece of the administration’s ongoing effort to improve care for residents and working conditions for staff in nursing homes,” said Acting Secretary of Health Alison Beam, during a news conference at Homeland Center in Harrisburg.
Beam, who was joined by leaders of four cabinet agencies as well as a nursing home worker and resident, noted this is the first in a series of five packages of proposed regulations that are based on the latest research, input from subject matter experts and industry stakeholders and informed by lessons learned during the COVID-19 global pandemic.
With the announcement the department has submitted the first installment of proposed nursing home regulations to the General Assembly, the Independent Regulatory Review Commission and the Legislative Reference Bureau. When the proposed regulations are published in the PA Bulletin a 30-day public comment period begins. Once published, comments may be submitted to the Department of Health via email: RA-DHLTCRegs@pa.gov.
The Department of Health is concurrently working on the other four packages of proposed regulations that will include proposed updates to other critical topics including change of ownership, staff development, staffing ratios and infection control and prevention. These packages will follow the same process for public comment as this first package of proposed updates.
“The Wolf Administration is looking at long-term care in a comprehensive manner and we are committed to getting the proposed updated regulations through the regulatory review process by the end of 2022,” added Beam. “Nursing home regulations have not been updated in nearly 25 years. Given the magnitude and importance of the regulations for more than 72,000 nursing home residents and their families, publishing the proposed updates in packages will allow each section the opportunity for appropriate feedback during the public comment period.”
Adam Marles, the CEO of LeadingAge PA, which represents non-profit long-term care providers, said the state isn’t providing enough financial support. “In its own proposal, the Wolf administration discloses it’s not even sure of the implications but acknowledges nursing home providers will bear much of the cost at a time when everyone understands they can least afford to do so,” Marles said in a statement. “Our members support best staffing practices and provide high-quality senior care, but a lack of state funding continues to stretch our resources to the very limit.”
Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which represents for-profit long-term care facilities, said the health department’s plan illustrates the agency is “out of touch” with the needs of providers and workers. He said the state’s higher standard of care will force the industry to hire an additional 7,000 direct care workers “who do not exist” and will cost providers more than $300 million annually.
“In our current operating environment, this proposed regulation is an unattainable, unfunded mandate that will cripple an essential component of the long-term care continuum in one of the oldest states, in terms of population, in the entire country,” Shamberg said in a statement.
Industry officials also said they are still reeling from the COVID-19 pandemic and all the extra costs including protective equipment, which are ongoing.
The regulations will apply only to the 692 licensed skilled nursing facilities regulated by the Department of Health. Personal care homes and assisted living homes typically housing residents with less acute health care needs are regulated by the Department of Human Services under separate regulations.
The first package of proposed regulations focuses on adding 1.4 required hours of direct care for residents each day to increasing the minimum standard from 2.7 to 4.1 hours within a 24-hour period.
“For many years, residents and long-term care ombudsmen have recognized and reported what more than 100 national studies and reports have shown, that the current minimum staffing requirement in Pennsylvania falls short of meeting the needs for quality of care and quality of life,” said Department of Aging Secretary Robert Torres. “As Pennsylvania’s senior population continues to increase, these overdue updates will help ensure that skilled nursing facilities provide residents with high-quality care now and in the future.”
The package also requires skilled nursing facilities to comply with the CMS regulations and requirements. “Skilled nursing facilities are both homes and caretakers, and we must be sure that these facilities are structured and staffed in a way that can deliver the level and quality of care that residents require and deserve,” said Acting Human Services Secretary Meg Snead. “Our priority must always be what is best for resident care, especially as we continue to learn from and seek to strengthen defenses for nursing homes and long-term care facilities in light of the pandemic. These revised and enhanced regulations will help make this possible.”
Skilled nursing facilities and long-term care facilities were disproportionately affected by the impact of COVID-19. “Robust and ongoing support for all skilled nursing facilities and long-term care facilities has been, and will continue to be, critical in the efforts to battle the pandemic and protect residents and staff,” said Beam. “Lessons learned during the pandemic are being incorporated into the new regulations.”
Support during the pandemic included the provision of personal protective equipment (PPE), infection prevention and control technical support, staffing support, outbreak response, and ongoing testing. This assistance was provided directly by the Department of Health and through the Regional Response Health Collaborative (RRHC) program and the Regional Congregate Care Assistance Teams (RCAT) coordinated by several state agencies.
Department of Health Highlights May 2021 Nursing Home Inspection, Sanction Information Amidst COVID-19 Pandemic
The announcement of new regulations followed within minutes release of the DoH’s May 2021 report, on nursing home inspections and sanctions. During the month, nursing home surveyors conducted 456 inspections, at 322 nursing homes, including 293 complaint investigations. Of these inspections, 76 were COVID-19-specific investigations. There were four new sanctions finalized against nursing care facilities in the past month resulting in a total of $142,850 in fines.
Individuals can file complaints about a nursing home with the department in several ways: anonymously by calling 1-800-254-5164, filling out the online complaint form, emailing firstname.lastname@example.org, or sending the complaint in the mail to the department.
The inspections include information on nursing home patient care and building inspections. If a facility is cited for not following regulations during the survey, it must submit a plan of correction that includes what will be done to fix the issue(s) and a completion date for the resolution. The department will conduct a surprise follow-up inspection to ensure issues are resolved. Surveys are posted to the website 41 days after the survey is completed.
The Department of Health also conducts surveys on behalf of the Centers for Medicaid and Medicare Services (CMS). These surveys include federal certification and recertification, complaint surveys, building safety surveys and others.
The department maintains a searchable database, which allows the public to view patient care surveys, building safety surveys, size of the nursing home, type of ownership and additional information about each of the nursing homes in the state. The department oversees 692 nursing homes with more than 88,000 beds in Pennsylvania, in addition to other facilities, including hospitals, ambulatory surgical facilities, home care agencies and others.
While residents and staff at skilled nursing facilities are receiving vaccine, it is essential that everyone remain vigilant regarding the potential spread of COVID-19 in congregate care facilities. Data regarding LTCF cases can be found on the department’s LTCF data page.
More information regarding case information for all nursing homes, guidance provided to nursing homes, the orders in place, fact sheets and frequently asked questions documents to assist in regard to what is being done by the state to assist nursing homes can be found on the department’s COVID-19 nursing home page.
You can find the latest guidance on nursing home visitations here.