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Kentucky's nursing homes are among nation's worst. Will state lawmakers do something?

Lexington Herald-Leader - 1/10/2020

Jan. 10--Several Kentucky lawmakers are sponsoring bills to improve conditions in the state's nursing homes, which have ranked among the nation's worst. But such legislation typically perishes in Frankfort, where the nursing home industry is a big campaign donor with much political clout.

Among the proposals is House Bill 215, which would establish staffing standards for nursing homes, such as at least one nurse's aide for every nine residents during day shifts; for every 10 residents during evening shifts; and for every 19 residents during night shifts. The bill also would set rules for how many nurses would have to be on duty at different times to oversee resident care.

"Inadequate staffing is the basis for so many of problems that we see. Most nursing homes are owned by for-profit companies, and unfortunately, one way that you make a profit is to keep your costs down by not hiring as many people as you should," said Wanda Delaplane, a nursing home reform advocate in Lexington who has testified to state lawmakers.

Federal law only requires that nursing homes have "sufficient" staff to meet residents' needs, although states are invited to set their own more rigorous standards. Kentucky has chosen not to, and the state's nursing homes regularly are cited and sued for neglect as unattended residents fall and get hurt, soil themselves in bed and suffer bedsores from lack of movement.

One Northern Kentucky nursing home resident crashed down the stairs in his wheelchair in 2016, suffering fatal injuries, and went undiscovered for the next nine hours because staff members did not notice his body or realize he was missing. Overall, nearly half of Kentucky's 282 nursing homes are rated as "much below average" or "below average" by the federal government based on poor scores for patient care, staffing and health inspections.

However, in past years, the General Assembly has rejected bills like HB 215, calling for better nursing home staffing, without so much as a committee hearing.

"I don 't know that we'll get much traction this session, but I at least wanted to file it. And I've already heard from some folks who are interested in it, so let's see what happens," said state Rep. James Tipton, R-Taylorsville, the sponsor.

Tipton said he decided to act after hearing from several constituents in his west-central Kentucky district who had bad personal experiences with nursing homes.

"Especially on the late-night shift, there were not enough -- just was not adequate staff there to monitor their loved ones," he said. "I think it's important that we care for all people in our society, and particularly the folks who tend to be in these facilities, because they're usually a little older. They deserve our respect and our compassion."

Two other proposals -- House Bill 228 and Senate Bill 36 -- would require nursing home staff to be training in properly caring for residents suffering from Alzheimer's and dementia.

Sen. Reginald Thomas, sponsor of the Senate bill, said he was motivated by his study on a special legislative task force on Alzheimer's and dementia. Many direct-care workers in nursing homes -- who often are low paid and without much training -- don't know how to handle the unpredictable and sometimes aggressive behavior of these special residents, Thomas said.

"In the year 2020, the fact that they get no training in Alzheimer's or dementia care really does surprise me," said Thomas, D-Lexington. "This is not a new phenomena. This is a growing trend that we're been facing with our aging population over the last 20 years."

The nursing home industry is represented in Frankfort by the Kentucky Association of Health Care Facilities, which has given several hundred thousand dollars in political donations in recent years, either directly or through its members, to Gov. Andy Beshear, members of the legislature and others.

Betsy Johnson, the group's president, said Friday that she will meet with the bills' sponsors in coming days to discuss their concerns with her industry and see if she can address them.

Johnson did not take a position on the bills, but her group traditionally has opposed the state imposing mandatory staffing levels. She said staffing rises and falls based on each facility's day-to-day population and residents' "acuity," or how alert and active they are. It has been an ongoing effort for the industry to build a qualified direct-care workforce, especially in a tight job market, she added.

"I think our members have consistently said they would like to hire more people," Johnson said.


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