Oklahoma Legislature Urged to Boost Nursing Home Staffing Rules

A Seminole woman pleaded with Oklahoma state lawmakers recently to “demand changes in the staffing and other requirements of our state’s long-term care facilities.”

“We tried to do precisely that earlier this year, but the Republicans blocked it,” said Rep. James Lockhart, a Democrat from Heavener, said that while a bill to do just that was introduced earlier this year, Republicans blocked it. The super majorities in the GOP-controlled Legislature also cut $2.2 million from the budget of state Health Department, which oversees the regulation and inspections of nursing homes in the state.

June Ballou told lawmakers that her 98-year-old mother — who is legally blind, hard of hearing, has crippling arthritis, suffered a stroke, and has short-term memory that is “only a few minutes long” – had to be moved into a Norman nursing home approximately two years ago.

“Because of these handicaps, she requires help with every aspect of daily living,” Ballou informed members of the House Committee on Long-Term Care and Senior Services in a Sept. 16 email.

However, staffing in the nursing home is sometimes insufficient, Ballou asserted.

“We have learned that nursing homes meet state-mandated staffing requirements that sometimes are not adequate to meet the needs of the residents of a particular nursing home,” she said. As a result, sometimes the residents miss meals, baths and oral care, and are left out of daily activities such as shopping trips, “because the few aides on duty do not have time to attend to all of their daily tasks.”

Salaries and absentee owners are two primary problems in the industry, said Lockhart, a member of the House’s Long-Term Care and Senior Services Committee. There is high turnover in certified nursing assistant positions because of low wages.

“The same rings true for the long-term care surveyors (nursing home inspectors)” who work for the state Health Department, Lockhart added. “They get trained on how to inspect nursing homes, and learn the state and federal regulations,” then quit to take other jobs in the health care industry that pay better.

Besides the low pay, Lockhart said, long-term care surveyors “spend a great deal of time” on the road, inspecting nursing homes “all over the state,” and are summoned to staff meetings in Oklahoma City. “Travel and spending so much time away from home are often the reasons surveyors give when they resign,” he said.

“Due to the nature of this work, we hire a lot of Registered Nurses for surveyors, said Dorya Huser, chief of Long Term Care Service in the State Health Department. “We do have trouble keeping them, as they are in great demand. I maintain a core stable force, but then we lose 20 percent to 25 percent of our staff annually.”

Salaries in the private sector are “very competitive,” Huser acknowledged, “and we are still below those salaries in many areas.”

Nevertheless, she also said she’s uncertain whether low pay or other factors are the principal reason for the high turnover.

“This job requires lots of training, long hours and travel on a routine basis,” she said. “We have tried to increase staff so we can reduce the workload demands and shorten those hours, but have not been able to reach our goal. In order to meet our mandates, we have to work a lot of overtime.”

Huser said she is having trouble filling several vacancies now, and not just among the surveyors. “One thing impacts another, so not having enough surveyors can be compounded by a shortage of management and office staff and further complicate operations.”

Huser said her staff includes:

• 72 surveyors to inspect 322 nursing homes in Oklahoma;

• 12 surveyors to monitor assisted living centers, residential care facilities and adult day-care centers, which collectively number about 270 facilities;

• Five surveyors to inspect 86 facilities for the developmentally disabled;

• Six life safety code surveyors who perform physical plant inspections on nursing homes and facilities for the developmentally disabled.

The Health Department counted 322 nursing homes and continuum-of-care facilities in Oklahoma this year, a loss of 33 over the past seven years. During that same time frame, the number of residents grew by more than 700: from 18,543 in 2007 to 19,304 last year; the head count has since fallen by almost 300, to 19,006 this year.

Lockhart said among other things his bill, HB 2901, would have increased Oklahoma’s mandatory direct-care-staff-to-resident ratios, particularly at skilled-care facilities.

Source: Oklahoma House of Representatives