Kentucky lawmakers want a hearing on nursing home staffing. Why it might not happen.

Oct. 05--Several state lawmakers say they want a public hearing this fall addressing the problem of inadequately staffed nursing homes in Kentucky, the subject of a recent Herald-Leader series. And a Republican leader of the key committee on health care said she is getting letters from dozens of concerned nursing home residents in her district, urging her to support minimum staffing standards for the facilities.

"It sounds to me like a public discussion is due on this sooner rather than later," state Sen. Julie Raque Adams, R-Louisville, said this week. Adams is co-chairwoman of the legislature's Interim Joint Committee on Health and Welfare and Family Services.

Meanwhile, Adams said, she plans to meet in coming weeks with her unhappy constituents in their nursing homes to learn more about the risks of having too few nurses and nurse's aides on duty to care for residents.

"I don't know what's going on behind the scenes, but there does seem to be some sort of initiative emerging here from the residents," she said. "This is clearly an important issue to them."

Another health care committee member, state Sen. Reginald Thomas, D-Lexington, said in a separate interview: "Of course we should be looking at this."

"We have some of the worst nursing home ratings in the country here in Kentucky. Why would we want that?" Thomas asked. "We need to have standards for how many employees are on duty taking care of residents. The only time we talk about nursing homes in Frankfort, it's for tort reform, to stop the so-called frivolous lawsuits after someone gets hurt. Maybe we should stop people from getting hurt."

However, there might not be enough time left for lawmakers to discuss nursing home staffing in upcoming meetings of the health care committee, said its co-chairwoman, state Rep. Addia Wuchner, R-Florence.

The committee is scheduled to meet Oct. 17, Nov. 27 and Dec. 12 to discuss health-related issues of relevance to policymakers before the 2019 General Assembly convenes in January. But the agendas for those hearings are "jammed full," Wuchner said Thursday. So she cannot commit to discussing a bill pre-filed for the 2019 session that would set staffing standards for nursing homes, she said.

An identical bill was ignored during the 2018 legislative session last winter, despite the sponsor, state Rep. Rick Nelson, D-Middlesboro, repeatedly calling for a committee hearing at that time.

"Given the attention this subject deserves, we still have so many items we need to present before the end of the year," Wuchner said Thursday. "So I just don't know."

In a recent series of stories, the Herald-Leader reported that 43 percent of Kentucky's 284 nursing homes this year were rated as "below average" or "much below average" by the U.S. Centers for Medicare and Medicaid Services because of serious problems with the quality of care they provide their roughly 12,500 residents. That's among the worst collective ratings for nursing homes in the country.

One of the most frequently cited problems in state-issued deficiencies -- and in the negligence and wrongful death lawsuits that follow -- is inadequate staffing at the nursing homes. In interviews with the Herald-Leader, industry officials acknowledged having a hard time hiring and retaining enough nurses and nurse's aides because of the stressful work and comparatively low wages.

Federal law only requires that nursing homes have "sufficient" staff to meet residents' needs, including a registered or licensed practical nurse on duty at all times.

Although the individual states are invited to set their own more rigorous standards, Kentucky has not done so. Nelson is only the latest in a series of state lawmakers unsuccessfully to propose minimum staffing standards for Kentucky's nursing homes.

"I was the one who carried the staffing bill one year, back in the late 1990s," state Rep. Mary Lou Marzian, D-Louisville, recalled Thursday. Marzian is also a member of the interim joint committee on health care.

"I started with a specific ratio of so many staff members needing to be on duty at all times for so many patients, and as the session went on, it just got watered down and watered down until it was so tepid that there was basically nothing left," Marzian said. "To be honest with you, I don't even remember if anything passed in the end. If it did, there wasn't much to it."

"The nursing homes, they've got lobbyists up there and they spread their money around to people and they generally get what they want," Marzian said.

Nelson, who sponsored the 2018 nursing home staffing bill and pre-filed another for the 2019 session, said he would be "delighted" to testify before any legislative committee that wants to hear from him.

Nelson's bill would require one nurse on duty for every 21 residents during the day and every 29 residents at night. It would require one nurse's aide for every nine to 10 residents during day and evening shifts and every 19 residents at night. Larger facilities would need nurse supervisors on staff. And nurses who were assigned to administrative jobs, filling out paperwork in offices instead of caring for residents, would not count toward the minimum ratio.

Facilities that failed to meet those ratios for two consecutive days would be barred from taking new admissions until they can demonstrate compliance, while facing fines of up to $1,000 for each day.

"I'm hoping people will get outraged and there will be some movement on this," Nelson said this week. "People just don't realize how lousy it is in some of these places, not unless they have someone in a nursing home. They just don't know what it's like in there."

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