this post was submitted on 22 Apr 2024
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The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes, Vice President Kamala Harris announced.

The controversial mandate requires that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift, according to a White House fact sheet.

Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in, with rural communities having longer timeframes, and temporary exemptions will be available for facilities in areas with workforce shortages that demonstrate a good faith effort to hire.

The rule, which was first proposed in September and initially called for at least three hours of daily nursing care per resident, is aimed at addressing nursing homes that are chronically understaffed, which can lead to sub-standard or unsafe care, the White House said.

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[–] [email protected] 131 points 7 months ago (27 children)

The controversial mandate

I wonder what the controversy is...

Nursing home operators strongly objected to the minimum staffing proposal in September, saying they already struggle to fill open positions. Such a requirement could force some facilities to close.

Oh, of course, they don't want to pay people. These business owners should go back to econ 101, the labour market is just another market. If you can't get enough people at current prices, you need to PAY MORE.

Mark Parkinson, CEO of the American Health Care Association, said in a statement Monday. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis.”

Oh, it's funded. Two steps. Grab your wallet, Mark. Look in your wallet. There is your funding.

The proposed staffing mandate has also split Congress, whose approval is not required. A bipartisan Senate bill and similar legislation introduced by House Republicans would prohibit the Department of Health and Human Services from finalizing the rule.

The only time you can reliably expect the US Congress to actually do anything for their fat paychecks is when it has to prevent other people in government to do their jobs.

[–] just_another_person 40 points 7 months ago (1 children)

Every point you made is legit, but just like psychiatric hospitals and asylums of yore, the statement you quoted is a threat that they (the profit-based company) will just stop operating certain locations if people (or the government) don't pay up. They will literally leave the elderly in the front parking lot and shut the place down if they can't keep their profit margins is what I'm reading into that statement.

For those unaware, I'm referring to the Reagan administration coming down hard on discontinuing the funding for a lot of government funded psychiatric and elderly care facilities in the 80's. You can read the Wikipedia article, but it doesn't really address the insane power these awful and privately operated companies hold over an entire segment of the population in this country, and hold tax dollars as ransom "or else".

That man in that quote is making a thinly veiled threat to repeat this shit again.

[–] Nurse_Robot 24 points 7 months ago (21 children)

There's a difference. Psychiatric facilities struggle with funding, nursing homes ABSOLUTELY do not. Have you seen the cost of living in even the shittiest nursing homes? It's common practice to be paying upwards of $10,000 per month, per resident. Nursing homes have all the money they could ever want, they're just greedy fucks who purposely utilize dangerously understaffed facilities to maximize profit for those at the top.

[–] just_another_person 8 points 7 months ago

They were lumped together in the Reagan administration culling payments for all times of those though. There are few protections for the elderly even still. You don't need to dig deep and find a zillion hits about these companies raising care rates out of nowhere to vacate tenants. It's absolutely insane, and there should be laws against it top to bottom.

[–] MonkRome 5 points 7 months ago (1 children)

Plenty of states it's much higher, in Minnesota the rate is set by the state according to patient need. It's not unheard of to pay $15k a month as $14k month is the average cost per resident.

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[–] [email protected] 37 points 7 months ago

Mark Parkinson is a trash human being. Let his name forever be dragged through shit in search engines.

[–] BigilusDickilus 6 points 7 months ago (2 children)

Chances are that Mark Patterson is not a medical service provider. I am sure he is very well compensated, but he would be association staff, not industry.

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[–] ATDA 106 points 7 months ago (1 children)

It's not controversial if only monied interests say so.

Good for the admin though keep pushing.

[–] [email protected] 22 points 7 months ago* (last edited 7 months ago) (2 children)

I often go to nursing homes for medical calls, and asking for basic patient information is always a treat at the crappier ones.

Pro-tip: when the medic asks you things like "What are we here for?", "How long have they been having this issue?", or "What's their medical history?" you don't actually have to answer. Just give a blank stare and say "I don't know, I just started my shift" or "They're not my patient". All you have to do is give the ambulance crew the patient's name and birthday, and even that's optional.

Is the patient dead and you don't know when it happened? Say "I was talking to them a few minutes ago!" even if they're cold to the touch. Bonus points if the pt has a DNR and you don't give it to the medic.

If all that is too much work, say "I'll go check" and find somewhere to hide until they leave with the patient -- this situation is their problem now.

[–] Fondots 17 points 7 months ago (1 children)

I work in 911 dispatch, nursing homes are one of the banes of my existence.

Do they have any medical history we should know about?
No.
Oh, I guess they're just putting perfectly healthy 57 year olds in nursing homes now, good to know.

Half of them can't tell me the address of the damn place they work, which is really nice when they call from their cell phone which barely gets any signal inside the building. Sometimes it's a crapshoot if they can even tell me the name of the facility

For whole lot of the people who work there, at least at the homes around me, English isn't their first language, and they don't speak or understand it very well and speak with a very heavy accent. I'm not knocking them just for that though, they speak more languages than I do, and are clearly trying to make a better life for themselves, I certainly can't fault them for that, but it does make me a little concerned for their patients. If I, as someone with all of my mental faculties and hearing intact, can barely communicate with you, how effectively can they be treating and supporting patients who often have significant cognitive and/or hearing impairments?

Don't get me started on the med techs. I'm not any kind of a healthcare professional, so I have only the vaguest idea what their role actually is in a nursing home, but from when they call 911 you would get the impression that they're kept in a dark soundproof closet until they need someone to call 911, then they're abruptly yanked out of the closet, spun around a few times, hit over the head with the phone, and told to call 911 while a strobe light flashes in their face, because they never have any idea what's going on

Now don't get me wrong, some nursing home staff are great, they have all of the information ready when they call, they're polite, professional, everything I could hope for, but unfortunately they're kind of the exception. 90% of the time when I see a call coming in from a nursing home I need to brace myself to deal with someone who is just an absolute mess, disorganized, ill-prepared, unintelligible, uncooperative, sometimes outright rude. Sometimes I consider myself lucky if they don't just outright hang up on me halfway through the call.

Also some of them love medical jargon, and as I said I'm not a medical professional. They'll call, rattle off a bunch of stats and vitals that mean nothing to me and aren't going in my notes even if I could type as fast as they're spitting them out. When I try to determine what the chief complaint is they'll spit out something like "their potassium is low," forcing me to ask for further clarification in plain english, so I know whether to code it as a cardiac thing, a respiratory thing, etc.

[–] littlewonder 9 points 7 months ago* (last edited 7 months ago) (1 children)

Your comment about people who don't speak English fluently reminded me to take a moment to appreciate that there are a non-zero number of asshole racists who, by nature of being cared for by (at least in some circumstances) people of varied races, do indeed die mad.

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[–] andros_rex 36 points 7 months ago* (last edited 7 months ago)

They shouldn’t give exceptions for “good faith effort to hire.” If you can’t hire someone, clearly you aren’t matching what the market demands and need to improve working conditions and pay.

Just like “emergency certifications” in teaching, when the solution to “we don’t have enough qualified people” becomes letting any one with a pulse in, we end up with a race to the bottoms in employee qualifications, pay and working conditions.

You cannot expect someone go through years of school, with additional specialized training, sometimes even masters or doctoral level degrees, to work for substandard wages. In the medical field especially - the mobile and qualified can make bank as travel nurses, why would they bother with you?

[–] BigMikeInAustin 26 points 7 months ago (1 children)

If there are too many patients, can that Texas politician's grandma give up her life for the economy?

(99% positive the politician was from Texas. Pretty this statement wasn't from Ted Cruz, but maybe. During COVID saying that grandmas in nursing homes would give up their life to open up lockdowns to restore the economy.)

[–] JesusSon 14 points 7 months ago (1 children)

You are thinking of Dan Patrick, he is the Lt. Governor making him the 2nd biggest cunt in Texas right behind Abbot but ahead of Paxton and Cruz. Though, one could argue that the biggest piece of shit stuck to the bottom of Texas's shoe is Paxton I prefer to lump all 4 in the same bag of dicks.

[–] BigMikeInAustin 5 points 7 months ago

Thanks.

Yeah, they are just different faces of the same evil.

[–] Ultragigagigantic 18 points 7 months ago (1 children)

Isnt a big reason the rail workers had such shitty schedules us because they are understaffed as well?

[–] [email protected] 5 points 7 months ago

Correct. They need to strike a hell of a lot harder, and Biden needs to back the union harder. The owners of the rail companies are selfish greedy pigs.

[–] kikutwo 16 points 7 months ago

I worked on skilled nursing facilities insurance during the pandemic. Mostly a horror show by owners who don't GAF about your grandpa and would rather spend money on their personal vehicles than invest in adequate staffing and maintenance. Disgusting group of people.

[–] [email protected] 7 points 7 months ago (1 children)

I'm curious how they came up with 3.48 hours. Does rounding it up to 3.5 really make that much of a difference?

[–] scutiger 13 points 7 months ago

They're probably working with larger numbers of hours, like in terms of years, and compromises then lower the numbers that later get divided back down into fractional hours.

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