Pa. nursing homes get ’F’ from national group

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By David Wenner | dwenner@pennlive.com

Pennsylvania nursing homes on Monday received a failing grade from a national advocacy group, which gave it one of the worst report cards in the nation.

Families for Better Care based its report card on eight measures collected by the federal government. These include number of problems found during government inspections, staffing levels and number of verified complaints. Pennsylvania ranked among the bottom ten states in measures including staffing hours per resident, number of facilities with deficiencies and portion of homes rated as average or worse than average by Medicare.

Brian Lee, the organization’s executive director, called understaffing a “chronic problem” at Pennsylvania nursing homes.

“A great way for Governor Wolf and Pennsylvania lawmakers to improve nursing home safety is by passing a tough staffing standard, something the residents sorely need,” he said in a news release. “But a new staffing standard isn’t enough, lawmakers must find a way to help nursing homes pay for any new staffing mandate if care is to improve at all.”

Quality issues at Pennsylvania nursing homes had much to do with the state’s two U.S. senators, Democrat Bob Casey and Republican Pat Toomey, pushing for more public disclosure of information about troubled nursing homes. 

Pennsylvania ranked 46th among the states, down from 32nd in 2014, the year of Families for Better Care’s previous report card. Pennsylvania received a D in 2014.

Texas ranked worst, ahead of North Carolina, Illinois, Georgia, New Mexico and Pennsylvania. The best grades went to Hawaii, Delaware, Alaska, Rhode Island and Utah.

Pennsylvania received better than a D for only two of the eight measures. It received a C for its proportion of homes with severe deficiencies, placing it roughly in the middle of the pack nationally. Still, that’s a significant drop from 2014, when Pennsylvania received an A and ranked eighth-best.

Pennsylvania’s best mark, a B, came in the area of professional nursing hours per resident. It’s rate of 1.83 professional nursing hours per resident was good for 16th place, down slightly from four years ago.

However, the 2.24 hours of daily direct care for residents of Pennsylvania homes put it near the bottom, at 47th.

Zach Shamberg, the CEO of the Pennsylvania Health Care Association, which represents nursing homes, said the report card is based on 2017 data. In 2018, he said, Pennsylvania nursing homes showed significant improvement in a few measures, including the number of homes with severe deficiencies.

But in an interview, he focused on funding shortages which he said impact homes’ ability to care for residents. Seventy percent of Pennsylvania nursing home residents are covered by Medicaid, the state-federal program for people with lower incomes. Medicaid funding hasn’t increased since 2014, with the average Pennsylvania home receiving $27.25 per day less than the cost of caring for each resident, according to Shamberg.

As a result, homes have trouble competing for workers, especially with the present historically low unemployment rate, according to Shamberg. “Frankly, right now we can’t find them … there is a workforce crisis around Pennsylvania and around the country.”

But rather than raising wages to attract more workers, Shamberg said the solution is more about “training and competency.”

It’s no secret nursing homes in Pennsylvania are struggling to provide adequate levels of certified nursing assistants, or CNAs, who provide most of the care for nursing home recents. At a recent hearing held by Pennsylvania lawmakers, representatives of nursing homes and a union representing CNAs agreed homes face a staffing crisis. They further agreed the crisis is the result of low wages paid to CNAs, with the wage crisis stemming from long-stagnant state payments for nursing home care. They stressed the typical nursing home resident has grown steadily sicker and in need of more care, but payments haven’t risen accordingly.

Union representatives agreed on the need for more funding, but urged lawmakers to give increases only to homes that are willing to spending it on staffing, not profit. The union also wants the state to set a minimum level of hours of care per resident, which the nursing home industry opposes.

The Pennsylvania Department of Health believes the homes’ poor grade and the drop in national ranking is due in part to increased state oversight and penalties against nursing homes, according to spokesman Nate Wardle.

If one state inspects and its penalizes its home more vigorously than another, that could result in its homes appearing worse.

In April, Wardle said, there were 541 inspections of 369 nursing homes, and 312 complaint investigations, resulting in fines penalties of more then $206,000 in penalties.

Beyond that, Gov. Tom Wolf supports mandated staffing levels, and has also assembled a group to look for policies that will improve nursing home safety, Wardle said.

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Pa. nursing homes get ’F’ from national group