POSTCRESCENT.COM WEDNESDAY, MAY 8, 2024 11A Most nursing homes in Wisconsin will need to hire more nurses or nursing aides to meet minimum re- quirements newly announced by the federal government, a mandate that some nursing homes worry they will struggle to meet amid chal- lenges exacerbated by the COVID-19 pandemic. The requirements, which will be phased in over the next few years, are the time the federal government has mandated a minimum stan- dard for nursing homes, a move that resident advocates have been urging for decades as mounting evidence showed a close link between levels and quality of care for residents. is the most important nursing home reform in said David Grabowski, a professor of health care policy at Harvard Medical School. need more in nursing Under the requirements, nursing homes will be required to provide ing that, at a minimum, is equivalent to nearly 3.5 daily hours of care per resi- dent. The change comes in the wake of the COVID-19 pandemic, which exposed chronic at many nursing homes that contributed to widespread outbreaks and deaths from COVID-19.
It was announced last month by Vice President Kamala Harris. But some Wisconsin nursing homes and their trade groups are worried they be able to the nurses and nursing aides required to meet the new requirements, especially as nursing home employment continues to lag be- hind pre-pandemic levels. are circ*mstances where impossible to meet the require- ments, particularly in rural said Rene Eastman, vice president of policy and at LeadingAge Wisconsin, a trade group that represents mostly non- nursing homes in Wisconsin. They also warn about potential unin- tended consequences of the rule, such as nursing home closures that limit pa- options and could have ripple ef- fects across health sectors. If nursing homes close, they say, hospitals might not have anywhere to discharge pa- tients in need of nursing home care.
That, they say, will contribute to crowd- ing in hospitals that, in turn, oth- er patients. Nursing homes that care for a large number of residents on Medicaid, which does not pay homes as much as Medicare or residents who pay out-of- pocket, may also struggle to meet the requirements, they argue. is an unfunded said Pam Klingfus, CEO of Christian Com- munity Homes and Services, a nonprof- it with two nursing homes in northwest- ern Wisconsin. much as we support the idea of quality, I would say the fed- eral government missed the mark by creating the mandate without giving the funds to support unclear whether existing funding is enough to support the extra hiring needed under the requirements, said R. Tamara Konetzka, a public health sci- ences professor at the University of Chi- cago.
There is a lack of transparency, she said, in nursing home spending and that makes it to follow the money and ensure enough is going to resident care and that is not excessive. much extra money is there in the system? No one really she said. Some researchers argue that nursing homes overstate their costs and that they are much more than they appear. A paper published in March by the National Bureau of Economic Re- search estimated that of nursing home industry are secretly fun- neled to owners through rents and fees paid to related entities that share a common owner with the nursing home. For example, nursing homes that own their building may sell that build- ing to a related entity, with whom they share a common owner.
The nursing home then pays an rent to that entity. The rental payments appear as an expense on the nursing books, but the owners, the paper ar- gues, likely are collecting that revenue after it is funneled through the related entity. At least three in nursing homes in Wisconsin did not meet the newly announced federal standards on an av- erage day in 2023 and would need to hire more nursing aides or nurses in or- der to the requirements in the coming years, according to a Milwaukee Journal Sentinel analysis of da- ta reported for the year 2023 to the fed- eral government. Most nursing homes have enough nursing aides. Aides are the ones who work most closely with resi- dents and help them some of whom cannot move freely or control their bladder or bowels get out of bed, go to the bathroom, bathe, eat and more.
Not having enough aides can result in resi- dents becoming seriously dehydrated, sitting in soiled diapers or sheets for hours on end, or developing bedsores, which can be deadly. While nursing homes will have to provide the equivalent of nearly 3.5 hours of care per day to each resident, at least 0.55 hours must be provided by registered nurses, and 2.45 hours by aides. About of 190 for- nursing homes did not meet the minimum requirements for RNs or aides on an average day in 2023, according to the Journal analysis. Mean- while, about of the roughly 90 nursing homes did not meet the requirements. For a home with 100 residents, it would need at least two or three regis- tered nurses and at least 10 or 11 aides on duty each shift to meet the minimum standards for RNs and aides, according to a fact sheet from the White House.
Nursing homes also will have to have a registered nurse on duty at all times. Currently, homes are required to have an RN on site for only eight consecutive hours a day. A 2022 USA Today investi- gation found that most nursing homes in the country failed to meet even that requirement in past years. Until now, the Centers for Medicare Medicaid Services, the federal agency that regulates nursing homes, never re- quired a number of nurses and aides. Instead, the agency had only re- quired to care for residents.
Wisconsin has a minimum standard in state law, but it is lower than the new federal standard and it does not specify a minimum number of hours for aides. Some resident advocates say the new federal standard go far enough. A 2001 study prepared for Congress found that the nursing home quality of care improved when there was enough to provide each resident with up to 4.1 hours of care per day. The government may grant exemp- tions to the new rule limited circum- Nursing homes may seek an exemption to the minimum rule if they truly try but hire enough and if the area has very few nurses or aides. They also may seek an 8-hour- a-day exemption from the regis- tered nurse requirement if the home is in an area with very few registered nurses.
The requirements are a bare mini- mum. The rule notes that nursing homes may need to provide more than the minimum hours of care if they care for residents with complex needs who require extra care. Nursing home employment has been slower than other health care sectors to recover since the pandemic and re- mains below pre-pandemic levels. In fact, nursing home employment has dropped by a little over since Febru- ary 2020, according to an analysis by KFF, a group that conducts health policy research. Some nursing homes that closed wings of their buildings during the pan- demic and lowered the number of resi- dents they would take have not been able to reopen those wings because of a lack of workers, said Eastman, of Lea- dingAge Wisconsin.
During the pandemic, both of Chris- tian nursing homes in northwestern Wisconsin had to cut back on the number of residents they would admit, said Klingfus, the CEO. They now average between and of the residents they had before the pandemic. we wanted to get to capacity my concern would be, where are the (work- ers) going to come Klingfus said. just not Klingfus said very to openings, especially at their campus in rural Polk County. recently hired a full-time recruiter to help existing openings.
She said wages have in- creased by close to in the last three years and the company regularly re- views wages to make sure they are com- petitive. The company also bo- nuses and other incentives to try to keep workers. She is working with a recruitment agency to hire interna- tional workers to openings she antic- ipates as some workers get ready to re- tire. If workers are scarce, nursing homes will have to raise wages to bring in the nurses and aides they need to meet the requirements, Konetzka, the University of Chicago professor, said. Wages for nursing home workers have gone up since the pandemic, but they remain below what a registered nurse or an aide makes working for a hospital or in home health, according to average wages re- ported by the Bureau of Labor Statis- tics.
Nationally, aides working in nurs- ing homes make nearly $19 an hour, while registered nurses make nearly $40 an hour, according to BLS statistics. As of last year, both of Christian nursing homes met the new minimum standards for registered nurses, aides and all that will be phased in over the coming years, according to the Journal Senti- analysis. But Klingfus is most worried about meeting the requirement to have a reg- istered nurse on duty at all times. The new requirements will be imple- mented in phases to give nursing homes time to hire more workers. Nursing homes located in urban areas will be ex- pected to comply sooner than rural ones.
Reporter Ken Alltucker of USA Today contributed to this story. 3 in 5 Wisconsin nursing homes must hire more under new rule Sarah Volpenhein Milwaukee Journal Sentinel USA TODAY NETWORK WISCONSIN military said it took control of the Palestinian side of the Rafah bor- der crossing between Gaza and Egypt on Tuesday as leaders vowed to push ahead with a plan to target Hamas in the southernmost city and as new talks resumed in Cairo. Israeli Prime Minister Benjamin Net- anyahu called the military advance- ment a step toward destruction of remaining military capa- bilities of In a military said its troops established con- of the Rafah border crossing lowing intelligence it was being used for terrorist The Rafah crossing is a crucial gateway for hu- manitarian aid between Gaza and Egypt. It was not immediately clear wheth- er the presence of Israeli tanks and sol- diers at the crossing had halted the of aid. The Israeli government issued a statement saying aid was still and blaming Gaza hunger issues on Ha- mas, but the U.N.
humanitarian agency OCHA said it was denied access to the crossing. Hamas called on the U.S. admini- stration and the rest of the world to put pressure on Israel to this escala- tion that threatens the lives of hun- dreds of thousands of displaced civil- across Rafah and the entire Gaza Strip. The Israeli advance the in- tention to disrupt talks and the release of prisoners for the sonal of Netanyahu and his extremist government, the Hamas statement says. storming of the occupation army to the Rafah border crossing with Egypt at dawn today is a dangerous es- calation against a civilian facility pro- tected by international the Hamas statement says, adding that closing the border crossing to exacerbate the humanitarian situation in the Strip preventing the of emergency relief aid through it to our besieged After warning Palestinians to evacu- ate eastern parts of Rafah on Monday, Israel carried out strikes on the city as it appeared to ramp up its preparations for a bigger military in the area, where more than a million Pales- tinians have been sheltering.
U.N. Secretary-General Antonio Gu- terres appealed to Israel and Hamas to work toward a truce deal and warned Israel that a full assault on Rafah would a strategic mistake, a political ca- lamity and a humanitarian Guterres, in a social media post, said he was and by Isra- latest military activity. rael has characterized as last stronghold in Gaza, does not happen. Aid agencies urge Israel to provide access to Gaza OCHA spokesman Jens Laerke said aid agencies in Gaza have only one day of fuel on hand. If no fuel comes in, would be a very way of putting the humanitarian operation in its he told the Times of Israel.
two main arteries for getting aid into Gaza are currently choked he said, referring to the Rafah crossing from Egypt and the Kerem Shalom crossing from Israel. The World Health Organization said Israel is also not al- lowing patient transfers through Rafah. While some non-fuel supplies have entered Gaza via the northern Erez crossing in recent days, the U.N. agen- cies said this was and cult to deliver to Rafah since it meant crossing active combat zones. will simply not be said James Elder, a spokesperson for the United Nations agency.
Rafah gate closes for an extended period, hard to see how famine in Gaza can be he said. The World Food Program said later on that its stocks would only last be- tween one and four days for the south- ern and central parts of Gaza. Even before the latest escalation in the the United Nations has re- peatedly accused Israel of restricting aid access despite famine warnings. Faced with growing international pres- sure, Israel had pledged to improve ac- cess but says U.N. agencies are to blame for not distributing aid more U.N.
agencies said they had pre- stocked some aid within Rafah but said there were very low supplies of water and high-energy nutrition supplies needed to treat malnourished children. Contributing: Reuters reiterate my appeal for Israel and Hamas to show political courage and spare no to secure an agreement Guterres wrote. stop the bloodshed. To free the hostages. To help stabilize the region.
This is a criti- cal opportunity we cannot to Netanyahu, squeezed by all sides, presses Rafah invasion A diplomatic push to reach a new Is- rael-Hamas seven months into the war is in Israel sent a dele- gation to Cairo after Hamas leaders on Monday said they would accept a re- cent proposal for a deal. However, not clear whether the agreement Ha- mas said it would accept meets requirements. Egypt warned that Isra- operation in Rafah threatened The Biden administration said it is reviewing agreement and would be discussing it with part- ners. Netanyahu is facing intensifying pressure to accept an Egyptian-Qatari proposal and avert the planned full Rafah ground invasion. The families of Israeli hostages held by Hamas are demanding their loved ones are given priority.
this crucial moment, while a tan- gible opportunity for the release of the hostages is on the table, it is of the ut- most importance that your government manifest its strong support for such an said the Hostages and Missing Families Forum, a group that represents hostage families, in a state- ment Tuesday. And Netanyahu is also attempting to appease far-right nationalist partners in his ruling coalition who have ap- peared to signal they would withdraw support for his government if the Rafah invasion, aimed at rooting out what Is- Fears mount that aid to area will be cut Kim Hjelmgaard and John Bacon USA TODAY Palestinians inspect the site of an Israeli strike on a house in Rafah in the southern Gaza Strip on Tuesday. HATEM Israel takes control of Rafah crossing.
