NURSING HOMES: L.A. Times Profiles Staffing Issues
Noting that hairdressers and veterinary assistants are required to have more training than nursing assistants in nursing homes, the Los Angeles Times reports that combined with "poor pay, the increasingly sick population of California's nursing homes and huge patient caseloads -- an average of 10 patients per assistant -- and you have a combustible brew long ignored in nursing home reform efforts." However, as nursing home reform comes to the front burner in the state, "for the first time, the focus is on the critical role of nurse assistants." Assemblymen Kevin Shelley (D-San Francisco) and Jack Scott (D-Altadena) have introduced measures that would require "more training, lighter workloads and more pay," which now averages $7 per hour. David Helmsin of the California Association of Health Facilities said, "I don't think there is any argument from anybody that there needs to be more and better trained staff." However, the Times reports that the nursing home "industry wants the state to pay for the added costs by increasing Medi-Cal reimbursement from $88 a day." This would cost the state an estimated $250 billion -- far more than the $35 million the state Legislature has earmarked for the reforms. And nursing home reform advocates don't buy nursing homes claims that they can't afford to raise staff salaries, and "point to the multimillion-dollar compensation packages received by the nursing homes top administrators."
So Little Time
In addition, the Times reports, the reform bills would only add 10 hours to the already minimal training required of nursing home assistants -- "high school dropouts and immigrants, single parents, foot-sore waitresses and unemployed construction workers," who often work double shifts and second jobs. And the measures would not increase state oversight of the training process. Adding to the problem is the "vicious circle of nursing home staffing, reported by nurse assistants but also acknowledged by the industry: Large patient loads and low pay lead to poor morale and high absenteeism, which raise patient loads." And since RNs are double counted as two nurse assistants, but won't do much of the drudge work like changing diapers, official staffing levels mean little. Shelley's measure would end the double counting of RNs, and "would also require that every patient receive 3.2 hours of care a day, up from the current 2.8 hour average," and rising to 3.5 hours by 2003 (Pyle, 5/28).