Sunday, July 22, 2012
Medicaid Reform Bill Sets Nursing Home Staffing, Maybe
Changes to the state’s Medicaid program, which Gov. Pat Quinn recently signed into law, were heralded as historic reform and are expected to shave billions off the state’s liability under the program. But the sweeping plan also attempts to resolve some longstanding disputes over health care policy in Illinois. This is part two in a two-part series that looks at those components of the new law. This is the second of a two-part story that begin yesterday.
Advocates say they were cut out of the process to determine nursing home staffing level requirements after the issue was pulled into negotiations over the Medicaid legislation. The reforms were spurred by investigations by the Chicago Tribune and The Chicago Reporter, which revealed neglect in the state’s nursing homes. When looking at both issues, lawmakers agreed that increasing staffing levels and more hands-on care would help to address some of the problems. “When it came time to actually move on rule-making process, the rug was pulled from under those advocates who had believed that, in fact, we could have addressed the issue though rule making,” said Chicago Democratic Sen. Jacqueline Collins.
David Vinkler, associate state director for AARP Illinois, said said he and others were surprised when they found the Medicaid reform legislation contained a provision for staffing levels. "Then we found in the Medicaid bill a piece of language that decided this on its own,” he said. “In our mind, [it] really kind of violated the spirit of the negotiations that we had.” He added, “We know there were no [nursing home] resident advocates in that decisions making process.”
Senate Bill 2840, which Gov. Pat Quinn signed into law, sets the requirement that 10 percent of the direct care be provided by a registered nurse. Under the new law, 25 percent of direct care must be provided by licensed nurse. However, after the new system goes into effect, staffing levels would also be tied to the level of care patients need, leaving no strict minimums across the board. “As a consumer, are you going to be able to figure out: ‘What [care] should I be getting?’ If you are not getting the minimum, how would you know?” Vinkler asked.
Vinkler said he doubts the state’s ability to keep track of requirements that are not uniform across every facility."We have serious questions about whether the Department of Public Health will be able to do that," he said. “Especially in Illinois, where we have had a history of really poor care, you have to have a minimum.”
Collins said she worries that the changes ahead will not solve the racial inequity of care that affects many people she represents. “I worry about the problem that has not been resolved, which is the staffing disparity. ... The patients at majority-white homes often had care from RNs, while those in black-only homes got care from [licensed practical nurses],” she said. “My intention is to revisit the issue because the problem I’m facing in my district has not been resolved.”
You can read Jamey's full report at: http://illinoisissuesblog.blogspot.com/2012/07/advocates-say-they-were-left-out-of.html