NURSING HOMES: Feeling the Pressure After Davis’ Veto
Gov. Gray Davis has vetoed AB 1160, which would have increased the number of certified nurse's assistants by providing additional training and wage hikes. In addition, the bill proposed an increase in fines for nursing home regulation violations and an alteration in the way nursing homes are paid through Medi-Cal. Specifically, the bill called for raising the staff-to-patient ratio over the next five years to 3.5 hours of direct care per day per patient. Davis vetoed the bill, having already approved the 1999 Budget Act, which included $36 million in state funds to increase the nurse-to-patient ratio from 2.9 hours to 3.2 hours of direct care; he estimated that AB 1160 would have cost the state an additional $250 million. The Chico Enterprise- Record reports that on Sunday, mere hours after Davis had vetoed the bill, all five of the city's nursing homes had placed advertisements seeking certified nurses' assistants, who provide the most direct patient care in nursing homes. Peggy Goldstein, the vice president of the California Association of Health Facilities, said, "We have a staffing crisis," adding that "CNAs work very hard for little pay -- with a strong economy and low unemployment it's hard to find people to take the job." Money from this year's budget could add 40 cents per hour to CNA wages, but it won't "make the job much more attractive," according to Goldstein. Goldstein did suggest that community colleges should start CNA programs "so people see this as a professional career." Pat McGinnis, director of California Advocates for Nursing Home Reform, lamented the loss of patients' rights measures that were vetoed, saying that Davis "didn't even mention patients' rights" in his letter and that "he still doesn't seem to get it." The California Association of Health Facilities plans to "convince Davis to put more money into nursing home staff pay" for next year's budget (Mitchell, 10/12).
The minimum nurse-to-patient ratio bill Davis did sign only "adds another layer of bureaucracy and cost to health care in California," an Orange County Register editorial asserts. The editors argue that while Davis attempted to increase nurse-to- patient ratios that were reduced by HMOs and other cost-cutting measures, "the response should be to reduce regulations, not increase them." Further, the editors cite Samuel Roth, assistant director of the Orange County Medical Association, who said, "We know that hospitals are quite concerned about health issues -- that flexibility might be taken away. Any increase in costs will not help." The editorial concludes, "Unless Americans want the government to ration all health care they way Canada does, they need to let politicians know that reforms need to embrace market elements, not more regulations and bureaucracy" (10/13).