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Illinois State Capitol in Springfield

Registered nurses will be required to provide at least 46 minutes of direct care each day to residents in Illinois nursing homes, pending a decision from a panel of state lawmakers.

The requirement stems from the state’s wide-ranging 2010 nursing home reform law, which mandated that skilled-nursing facility residents receive 3.8 hours of “nursing and personal care” each day by 2014, up from the current level of 2.5 hours a day.

As originally passed, however, the 2010 law did not specify how much of that care must be provided by a registered nurse.

The panel of lawmakers is considering a proposal that would fix that. The proposed rule would require a minimum of 46 minutes of care from a registered nurse each day. The figure represents 20 percent of the total 3.8 hours required.

Effect on CNAs

David Vinkler, associate state director of advocacy and outreach for AARP‘s Illinois legislative office, which supports the proposed rule, told the Chicago Tribune, “I wouldn’t be surprised if some homes might be staffing more heavily with [certified nursing assistants] in the absence of definition.

“That’s why it makes sense to do all of this,” Vinkler added. “You have to be comprehensive about how you address staffing in nursing homes.”

The legislative panel was originally scheduled to vote on the ruling March 6. However, it opted to delay the vote until at least April 17.

– by Matthew Ozga

This summer, the Centers for Medicare and Medicaid Services (CMS) requested public comments on its proposed approach (Excel doc) to the implementation of Section 6104 of the Affordable Care Act, which requires skilled nursing facilities (SNFs) to report the amount and type of their expenditures on direct care.

While PHI applauds the timely implementation of Section 6104, it has recommended modifications to CMS’s proposed approach based on the findings of a February 2009 CMS/National Direct Service Workforce Resource Center report entitled “The Need for Monitoring the Long-Term Care Direct Service Workforce and Recommendations for Data Collection.” PHI was the lead author on the report.

PHI’s recommended modifications include collecting and reporting information on:

• regular (base) salaries and hours separately from other types of salaries and hours (e.g. overtime wages and hours, bonus payments) in order to allow a more accurate calculation of average hourly direct-care worker wages;
• workforce stability and turnover; and
• health insurance benefits provided to direct-care workers separately from other fringe benefits.

PHI also recommends that the SNFs create a separate occupational category for “Certified Nursing Assistants” (CNAs) rather than including CNAs in one single “Nursing Assistant/Nurse Aide” occupational category.

These recommendations and others are explained in an August 1 letter (pdf) to the Office of Management and Budget’s Office of Information and Regulatory Affairs from PHI Government Affairs Director Carol Regan.

“We strongly believe that the availability of good quality data on the direct-care workforce providing long-term services and supports is fundamental to developing policies and standards to ensure quality and access for consumers,” the letter states.

For more information about the SNF reporting requirements on expenditures for direct care, contact PHI National Policy Analyst Gail MacInnes.

– by Gail MacInnes, PHI National Policy Analyst