Saying that nursing homes need to do more to earn the nearly $100 billion they get each year from taxpayers, the Biden Administration is proposing a new rule that would require nursing homes to have a registered nurse on duty at all times.
We’re hosed, South Dakota’s healthcare lobby told the Legislature yesterday:
The Legislature’s Study Committee on Sustainable Models for Long Term Care received warnings about the possible impacts from Tammy Hatting, who is chief operating officer for the South Dakota Association of Healthcare Organizations that represents hospitals and various other health care providers, and from Mark Deak (DAY-ak), executive director for the South Dakota Health Care Association that represents long-term care providers, including nursing homes, assisted living centers and congregate living.
Hatting described the Biden administration’s proposed rule for Medicaid- and Medicare-supported facilities as a tornado siren that’s sounding — “We don’t know if it will hit us or not,” she said — while Deak said it would be “a disaster” for South Dakota if the rule takes effect as now written.
…A recent SDAHO survey found 985 openings for registered nurses in South Dakota, more than the 893 who graduated from South Dakota institutions in the past year, and 27% of the new RNs headed to other states, according to Hatting. “The gap is widening,” she said [Bob Mercer, “Long-Term Care Panel Gets Warning on CMS Proposal,” KELO-TV, 2023.09.25].
SDAHO’s slideshow to the interim committee underscores their claim that, while recent research shows a relationship between nursing home staffing and quality outcomes, “it does not provide a clear evidence basis for setting a minimum staffing level.” On the question of a minimum registered nurse staffing level, the Centers for Medicare and Medicaid Services disagree:
Research shows the presence of an RN is strongly related to the quality of care and outcomes residents experience. Statistics have shown that as the number of RN hours increases, so does performance on the quality measures. Therefore, when there are lower levels or even no onsite RN presence, CMS is concerned about the health and safety of the residents [CMS, training document on nursing home staffing, retrieved 2023.09.26].
The nursing home lobby and everyone else have until November 6 to submit comment on the 24/7 RN requirement and other elements of the proposed new rule.
It seems to me that it makes sense to have an RN on staff, or at least a hospital nearby with RNs available as needed.
But, I’m not surprised there is a proposal that may be physically impossible to fulfill. Anyone do their homework before making the proposal?
Something has to give in long term care. People are living longer at unhealthier rates and it is causing these systems to collapse. While Good Sam certainly bears responsibility for its financial dire straits, they were representative of a larger trend towards insolvency for long term care options outside of integrated care systems. Sanford saved that organization, for better or worse. I don’t know how heavily the proposed rule would impact those operating in the space, but as it stands, most of these facilities remain solvent solely through rehab beds and subsidies.
$100 billion. Like nearly all else in healthcare, it’s a mere wealth pump for a few entitled CEOs, staffers, and their over-compensated boards. My mother was nearly the longest term patient at a small memory-care assisted living facility in a small town, county seat. In her years there not once did I see or hear of a visiting CEO, senior staffer, or board member at the facility. Thank goodness the facility manager and assistant manager, and their workers/staff were competent, caring, and put patients above all else.
Were I king, I’d cap salaries on nursing home/assisted living CEOs, senior staff, and board member compensation. This healthcare wealth pump must stop.
The US ought adopt the Biden administration nursing home staffing proposal. We are judged by how we care for our most vulnerable.
If your silent or boomer generation parents or grandparents need lower cost long term care – send them to Mexico, where on the average the care is better to as good at a fraction of the cost. (Of course, those old folks will tremble having to live with the consequences of a life-time of receiving what they voted for when they aligned with the republican governments hell-bent on pulling up the ladders of social welfare and domestic tranquility.)
(Oh, the things one learns hanging around old people. Diabetics in long term care have a longer life expectancy than do non-diabetics. Why? Likely it’s metformin. It’s likely that metformin for diabetics has become part of the long term care wealth pump. Metformin is often available over the counter in Europe, in Canada with a doctor’s note; but in the US requires a specialist prescription.)
Worthy assistant, what’s the law in Colorado?
Nursing homes in Colorado are required to have a Registered Nurse (RN) on duty at all times. According to the Colorado Department of Public Health and Environment, nursing homes are required to have a licensed nurse, such as an RN, available on-site 24 hours a day, seven days a week. This requirement ensures that residents in nursing homes receive appropriate and timely nursing care by a qualified professional.
Not so in Minnesota but in Minnesota an RN must be on call 24 hours a day.
This is why white privileged South Dakota politicians are clueless about Indigenous peoples culture. You’re welcome.
The Task: “Worthy and multicultural assistant. Please explain psychologically why American Indian cultures’ method of verbal communication in education and governance doesn’t always mesh with white peoples methods of written communication in education and governance.” – P. Aitch
Psychological factors contribute to the mismatch between American Indian cultures’ verbal communication and white peoples’ written communication in education and governance. Here are some key psychological aspects that help explain this disparity:
1. Oral Tradition and Collective Orientation: Many American Indian cultures have a strong emphasis on oral tradition, storytelling, and communal knowledge sharing. Education and governance practices within these cultures often rely on verbal communication, fostering a sense of community and shared understanding. In contrast, white cultures tend to prioritize written communication, which places more importance on individualism, formal documentation, and structured dissemination of information.
2. Contextual Communication: American Indian cultures often rely on contextual cues, non-verbal communication, and indirect communication styles to convey messages. The meaning behind words is frequently dependent on the broader context and relationships involved. In contrast, white cultures tend to place greater emphasis on explicit verbal messages and logical organization of information, which can be conveyed more effectively through written communication.
3. Relationship Orientation: Building and maintaining relationships play a crucial role in American Indian cultures. Verbal communication allows for immediate feedback, establishing trust, and fostering connections. White cultures, on the other hand, may prioritize task-oriented communication and formalities, which can be more efficiently achieved through written communication.
4. Learning Styles: American Indian cultures often value experiential and interactive learning, where knowledge is shared through dialogue, storytelling, and observation. Verbal communication allows for immediate engagement, clarifications, and connection with the information being transmitted. White cultures may lean towards more structured and linear learning approaches, often relying on written materials and lectures.
5. Historical Factors: Historical experiences, such as forced assimilation, colonization, and cultural suppression, have influenced American Indian cultures’ preference for verbal communication. These experiences have reinforced the significance of oral tradition, as it helped preserve cultural heritage, identity, and resistance against assimilation efforts. In contrast, white cultures’ historical development and technological advancements have favored written forms of communication.
It is important to note that these observations are generalizations, and both American Indian cultures and white cultures exhibit significant diversity with their respective communication styles. Recognizing these psychological factors helps facilitate a better understanding and appreciation for the differences, and offers opportunities to find effective communication strategies that blend verbal and written methods in education and governance, promoting mutual understanding and inclusivity.
It isn’t “physically impossible”, or even fiscally or financially impossible, to fill these jobs. Offer more pay. That’s how the market works.
I realize that the majority of nursing homes nationwide (not sure about SD) are for profit companies that need to make a profit. But that’s why you need regulation in for profit health care, to ensure that savings don’t come out of essential services.
Yes it comes with a cost. Based on the estimates in the article, somewhere between $15 million and $40 million. Perhaps the state could pay $5 million to put “Freedom Works” bumper stickers on wheelchairs.
More pay means less greedy profits and profit is the name of the game. Cut expenses to the bone and jack up monthly costs and still bitch about not enough profit.
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Turning nursing homes loose on poor elderly is sole province o\f magat guvs and leges.
Also unionize those RN’s so they don’t starve to death in Britton or Kadoka or Aberdeen or you name it town with long term care (not Polo). Not to hard if you want to get’r done.
I respect the Heck out of those nurses who dutifully serve quietly in long-term care facilities in SD and elsewhere. I do not subscribe to the doctrine that there must be an RN on-site on a 24-hr basis. I have known plenty of nurses who are Licensed Practical Nurses (not RNs) and few if any of us would be able to distinguish between the quality of care provided. There is nothing magical about the RN designation (in my experience). The only difference is in the level of commitment and dedication to the field of Nursing – which occurs independent of licensing criteria.
Curt
You may be right about the level of staffing needed. I leave that decision who deal with these matters regularly. I think we need to recognize that a cost that a large chain in Rapi City can absorb may be too much for a small facility on Lemmon or Philip and if more staffing is required, we may need to increase subsidies.
P. Aitch, thank your for sharing with us how responsible, progressive states treat the most vulnerable among us. South Dakota has no excuse. The wealth pump is not an excuse.
Wouldn’t it be a hoot if Governor Noem started asking grudznAIck some of the questions she must ask Mr. Fury?
grudz-that statement of yours truly rests on the concept that she has questions for her imported mouthpiece-Fury. Does it not?
Do you think he runs wild and free, Mr. Kammerer? Is he the caged, or the cager?
Young Mr. Fury strikes me as a svelte tiger of a man, roaming, never sleeping, on the prowl, where those in his neck of the jungle are always cocking one ear for the throaty growl announcing his presence.
John, FWIW, My mother was a nursing home administrator for Good Sam for many years, in several states. The CEO at the time (Mark Jerstad, Son of the founder) made it a point to visit every facility at least once a year. After his too-early-in-life death, the whole organization changed and not for the better.
This Nursing Home “Solution” is just another lap in South Dakota’s race to the bottom.
There are also more rules concerning staffing numbers in addition to RN’s. And first let me say as an employee of a stand alone city-owned nursing home, not for profit at that, there is not one new grad RN that wants or will start his or her nursing career in long term care in a small or remote community in SD.
The new proposal from CMS on staffing also pumps up the number of certified nursing assistants that must be on duty on each shift. As most businesses in SD, we are all in the same position of trying to find employees. You can read between the lines here.
Who distributes medications to the residents? They’re passed around during every shift, so I hope no one less than a registered nurse gets nears that cart.
When a resident of a care facility is dying, someone qualified has to enforce the DNR, call family members, and make arrangements with hospital/funeral home. Clearly, a registered nurse is needed for this position.
But, this is S.D. and it wouldn’t surprise me to get a phone call in the middle of the night from a custodian or nurse’s aide that my mom has passed.
The reality of nursing home care is that it is phenomenally expensive, and financial planners are going all-out to help their clients protect their assets. They create irrevocable trusts expressly for the purpose of preserving an estate which would otherwise be exhausted paying for a nursing home.
Another factor is the cost of assisted living. Many people sell their homes and use the proceeds up in expensive assisted living facilities. When the money runs out, they have to leave.
Consequently the typical nursing home resident arrives at the facility qualifying for Medicaid, unaware that once a person is on Medicaid, his options for long term care are limited.
Once you are on Medicaid, you are a beggar, and beggars can’t be choosers.
If you want to spend your last days attended by an RN, be prepared to spend your own money, don’t blow it on luxurious assisted living, and don’t plan to leave it to your heirs. If you have deliberately made financial decisions that qualified you for Medicaid, don’t complain about the quality of the end of life care the taxpayers are willing to pay for.
Yes, Mrs. Beal, socialized agriculture, socialized dairies, socialized cheese, socialized livestock production, a socialized timber industry, socialized air service, socialized freight rail, a socialized nursing home industry, a socialized internet, socialized gas well remediation and now a socialized water system are all fine with Republicans in South Dakota but then they insist single-payer medical insurance is socialized medicine.
Predictably this morning the Des Moines Argus Leader picked up the whining “testimony” from South Dakota Association of Healthcare Organizations and South Dakota Health Care Association about the threat of RN staffing to their wealth pump. Not once did the Argus mention the fact that other states require an RN on staff 24/7 and their nursing homes are doing fine.
Most elderly have far more to worry from the Medicaid clawback than from the estate tax. Of course the estate tax largely affects the wealthy and so is evil.
The truth is that many South Dakotans can outlive their retirement due to the high cost of nursing home care and living longer. They may need Medicaid in their final years. Now though we learn that it is not part of a system they built when they were working but rather they are beggars who shouldn’t complain about substandard care and apparently, ought to be grateful not tp be tossed out on their freeloading asses.