Lawmakers, who aim to enhance direct care for nursing home residents, recommend increasing the daily minimum staffing requirements from 3 hours to 3.6 hours.
However, a recent analysis by the nonpartisan office of state financial analysis shows that the move comes with a large price tag: $24.2 million, half of which will be taken up by the state through Medicaid payments.
“It'll be very difficult to pass this year,” said Sen. D-Meriden, co-chair of the Aging Committee. “Unfortunately… at this point, there's no room for it.”
Hochadel continues to defend the measure her committee voted to move forward in March, but said “we have a rocky path.”
“This is something we wanted to do and we're increasing the number of people looking after the elderly, but in this financial environment we have to make some difficult choices,” added Jane Garibay, D-Windsor, co-chair of the Aging Committee.
Lawmakers are tackling unprecedented challenges to the state's finances.
More than $500 million emergency federal pandemic grants used to fund ongoing programs will remain unavailable. The set of budget caps that have created huge surplus since 2017 must gradually undermine and reduce healthcare and other core programs, says democratic legislative leaders.
But the biggest concern from state officials will be accompanied by a massive expected cut in federal aid in the coming months.
Under staffing bills, nursing homes must provide a minimum of 3.6 hours of direct care to each resident every day. They should now provide 3 hours, but some homes are already at a higher level of staff.
Direct care is defined as practical care from registered nurses, nurse aides, or practical nurses, including feeding, dressing, and bathing.
The measure also imposes new penalties for violations. Facilities that do not comply with the increased staffing requirements could face a fine of up to $10,000 for each violation. The bill also gives state health commissioners the authority to suspend nursing home licenses or certificates or citations.
Leaders in the nursing home industry are opposed to the plan.
Matthew Barrett, president and CEO of the Connecticut Healthcare Facilities Association, said costs are just as challenging as recruiting staff.
“We have a refund system where costs increase interest rates. If we mandate an increase in facilities costs, we must refund them under the Medicaid program,” he said. “That's a challenge in any environment when there's a lack of staffing, but it's especially difficult to come up with the dollars to do that in the current fiscal climate.”
Earlier this year, he testified about the bill. “Due to the continued lack of staffing in the sector, nursing homes must insufficiently rely on increasing frequency with temporary nursing staff institutions to comply with these highly normative standards.”
Magmorelli, president of Reading Gauge Connecticut, representing nonprofit nursing homes and adult care providers, said he supports strong staffing but is worried about the costs.
“Now, everyone is very concerned about how much they are spending and the possibility of reducing Medicaid programs from the federal side,” she said. “Because of the lack of workforce, one sector needs to increase staffing, so we're going to raise the cost of all staffing. There are only a limited number of people in the healthcare sector.”
House Speaker D-Hartford Matthew Ritter said the lack of clarity regarding federal Medicaid funding has made it difficult to support many proposals, including increasing staffing for nursing homes.
“For me, one of the most unfortunate things about the situation right now is that uncertainty at the federal level has influenced many of our Medicaid decisions,” he said. “Whether it's the Aging Committee bill or the Medicaid Caucus' priority bill, we'll have to wait for more information from Washington.”
Congress is trying to achieve Medicaid and other programs savings over a decade to help pay the federal tax cuts proposed by President Donald Trump.
Connecticut expects to spend $11.6 billion on Medicaid this fiscal year. That approximately $4.7 billion is state costs, while the other $6.9 billion is covered by federal rebates.
But state officials fear Connecticut will lose hundreds of millions of dollars at best, and billions at worst, if Congress strikes all or most of its cost-cutting targets.
In addition to the uncertainty of federal funding, lawmakers also stand up to expired labor contracts for nursing facility staff.
More than 60 nursing home employees are in expired contracts as they spread among more than 60 facilities across the state. Another 3,500 healthcare workers who most support disabled clients in group homes are also scheduled to raise wages.
Although no specific work suspension date has been announced, SEIU District 1199 New England (the state's largest healthcare workers union) says it hopes lawmakers will expand Medicaid funding to help raise wages before the regular general meeting session ends on June 4th.
“We're also facing contractual issues with nursing homes, so we need to balance all of the different bills compared to the industry,” said Sen. D-Sprague, co-chair of the Approximately Expenses Committee.
“We have to acquire arms around the nursing home industry and provide direct care. (Several) nursing homes have closed over the past 12 months. As we continue with this process, we need to remember that we still want to have nursing homes.
