THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Saturday, January 20, 1996 TAG: 9601200275
SECTION: LOCAL PAGE: B5 EDITION: FINAL
SOURCE: By DEBRA GORDON, STAFF WRITER
LENGTH: Medium: 73 lines
The federal government should require nursing homes to have registered nurses on duty 24 hours a day, the Institute of Medicine recommends in a report released this week. Current regulations require RNs for eight hours a day.
The recommendation is included in a 250-page report on hospital and nursing home staffing that the institute completed at Congress' request. The request came two years ago amid media reports about adequate staffing in nursing homes.
An institute-appointed panel of experts recommended that government health-insurance payments to nursing homes be adjusted to offset the costs of increasing the RN nursing staff. It also said ``in exceptional conditions,'' states could waive the requirement for nursing homes that couldn't afford it.
Advocates for the elderly applaud the 24-hour RN recommendation.
``When you have illnesses at that age . . . your care is very complicated,'' said Sara Burger, of the National Citizens' Coaltion for Nursing Home Reform. ``Things can go wrong very, very quickly.''
Opposed to the institute recommendation is a state nursing-home industry group. Round-the-clock RN coverage is not necessary in all nursing homes for all residents, argued Valerie Perini, of the Virginia Health Care Association.
``Although it would be wonderful to have everything possible, many of our residents are in nursing homes with a lifestyle; they have a regular bedtime. So staffing through the night would almost be superfluous.''
One local nursing-home administrator said round-the-clock RNs would be a good idea, provided funding could be found.
``We have no problem or objection with 24-hour RN coverage,'' said Kit Thoma, administrator at Thornton Hall nursing home in Norfolk. ``But RNs are extremely expensive.''
In Virginia, increasing RN staffing to 24 hours a day would cost nursing homes about $32.6 million, according to a 1994 report from a committee appointed by Gov. George F. Allen to look into staffing at nursing homes.
The institute's recommendation comes as states are threatening to reduce funding for nursing-home care as the federal government considers changing the way it structures the Medicaid program. Medicaid pays for the care of more than 70 percent of Virginia's 30,000 nursing home residents.
Some nursing homes, such as Heritage Hall in Virginia Beach, which provide more specialized medical care, such as intravenous services and wound care, already have 24-hour RN staffing. They also receive higher Medicaid and Medicare reimbursements for patients who are more ill than most nursing-home residents.
Advocates for the elderly had hoped the institute would recommend staffing requirements for nurse aides, who provide the bulk of the care in nursing homes. They were disappointed.
``Staffing problems are the most frequent complaint we hear from family members,'' Burger said. ``We have always thought there should be a nurse aide staffing recommendation.''
The institute's committee did say that ``in some nursing homes there is a clear need for more nurse aides,'' and that inadequate nurse-aide staffing leads to increased risk of medical complications and expense.
It recommended additional research on the relationship between licensed practical nurses and nurse aides and the quality of care.
``The majority of formal complaints coming to us are related to inadequate staffing or poorly trained staffing or turnover,'' said Mark Miller, who, as Virginia's ombudsman in the Department for the Aging, receives complaints about nursing homes.
Forty-four states - but not Virginia - set their own minimum staffing standards for nurse aides. MEMO: The Associated Press contributed to this report.
by CNB