12/08/2024
We all know this, but here it is in print. We will be opposing any bill which proposes a change in the provider reimbursement methodology that the Oklahoma Health Care Authority is pursuing under the direction of their staff and board. The OHCA director reports to the Governor. The for-profit Care Providers Oklahoma Association is supporting this change. The current methodology rewards those facilities which have better staffing levels while facilities below staffing levels are not reimbursed at the same level. We must maintain the current methodology. Please stay alert regarding any prosposed legislation. Should you wish to receive a weekly status report, consider joining either the Oklahoma Silver Haire Legislature or the Oklahoma Alliance on Aging. The partnership of these two organizations, as well as the Council on Aging, are at the Capitol every week advocating for Oklahoma's vulnerable elders.
A group of nonprofit advocacy organizations is seeking to intervene in a
lawsuit that challenges new, federally
mandated staffing levels in nursing
homes.
The National Association of Local
Long-Term Care Ombudsmen is among
seven organizations hoping to ask a federal judge to deny a request made by the
nursing home industry and 20 state attorneys general for an injunction that
would block implementation of the new
staffing requirements.
The organizations have not yet been authorized to file their “friend of the court” brief, but approval in such circumstances is normally granted. The injunction is being sought in a lawsuit filed eight weeks ago in U.S. District Court for the Northern District of
Iowa, and seeks to block implementation of the Biden administration’s new staffing requirements. The lawsuit was
filed by Iowa Attorney General Brenna Bird and the attorneys general of 19 other states along with 19 industry organizations who argue the new requirements are cost prohibitive and will result in nursing homes closing down. Joining NALTCO against the attorneys general are the nonprofit organizations known as the Center for Medicare Advocacy, the National Consumer Voice
for Quality Long-Term Care, the LongTerm Care Community Coalition, California Advocates for Nursing Home Reform, Justice in Aging, and the Michigan Elder Justice Initiative. NALTCO’s role in the case is particularly noteworthy in that the organization is comprised of members of each state’s Long Term Care Ombudsman’s Office, which were created by Congress
in 1978 to serve as independent advocates for nursing home residents. Typically, each office, including that of Iowa’s Long-Term Care Ombudsman, operates within an arm of their respective state government. The result is that the ombudsmen’s national organization is now opposing the legal efforts of OP attorneys general in states where many of those ombudsmen now work.
In October, Bird said she was leading the court challenge of the staffing mandates to ward off a “mass shutdown of nursing homes.” In November 2023, Iowa Gov. Kim Reynolds announced her opposition to the new staffing rule, joining 14 other
Republican governors in signing a letter to President Joe Biden in which they argued the rule was “unrealistic” and would “harm the seniors, elderly and disabled it’s designed to help.” According to data from the Centers for Medicare and Medicaid Services, 14% of Iowa’s 422 nursing facilities were cited for insufficient staffing in fiscal year 2023, before the new requirements were enacted. That’s more than double the national average, which was 5.9%. Five other states – Hawaii, Michigan, Montana, New Mexico and Oregon –
had a worse record of compliance with the staffing requirements in place at that time. Advocates cite ‘excessive profits’ In their court brief, the advocacy groups argue that understaffing of nursing homes has been a decades-long problem leading to widespread injuries and death inside taxpayer-supported, profit-generating nursing homes that collect Medicare and Medicaid dollars to pay for resident care. For decades, the government has required only that nursing homes provide “sufficient” staff to meet residents’
needs but has left it to owners to define “sufficient.” The new standards establish specific, minimum nurse-staffing
requirements, such as the around-theclock presence of at least one registered nurse. Federal data indicates many nursing homes already meet some of the new standards, and, on average, those that operate as nonprofits exceed the newly mandated staffing ratios. The advocacy groups argue that the research that led to the formulation of the new mandates suggests they could save 13,000 lives per year. “The public interest favors prompt implementation of the staffing rule,” the groups said in their brief. “The public has a compelling interest in having vulnerable nursing home residents – their family members, friends, neighbors –receive appropriate care and in having their tax dollars spent on resident care, not on excessive private profit for owners and operators.”Among the 46,520 comments received by the federal Centers for Medicare and Medicaid Advocacy in response to the proposed rule were comments submitted by front-line caregivers working in nursing homes – some of which are included in the advocacy groups’ brief to the court. One registered dietitian reported that in the facility where she worked, staffing shortages were so severe the nurses
would periodically declare a “med holiday” and throw away all the medications intended for residents on one shift because they didn’t have time to pass them out. Others referenced their colleagues
being unable to provide toileting assistance, baths or food for residents. Some wrote of residents wearing the same clothes for a full week because there wasn’t enough staff on hand to help them change clothes. The groups also cite a recent study that found that some nursing home owners are hiding their profits through a
practice called “tunneling,” in which they pay other companies that they own inflated prices for resident care. One 2024 study found that care facilities in Illinois hid 63% of their profits by paying
inflated prices to related entities. In New York, a study found that owners there spent more than $1 billion – 16% of their operating expenses – on payments to related parties. The Iowa-led lawsuit is one of two currently working their way through the federal court system. The other lawsuit, filed in Texas, was initiated by the
American Health Care Association, a lobbying organization that primarily represents for-profit nursing homes. Some observers say the litigation will have little impact on the fate of the staffing mandates since the Trump administration is expected to do away with the requirements once the president-elect take office in January 2025. Iowa Capital Dispatch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains
editorial independence.
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