RI's nursing home staffing law isn't being enforced. Now there's a new federal mandate.

The Rhode Island law that was supposed to set minimum staffing standards for nursing homes has never been enforced, but a new federal mandate carries much the same impact.

Under new rules announced by the Biden administration on Monday, all nursing homes that receive federal funding through Medicare and Medicaid will be required to meet certain staff-to-patient ratios.

Rhode Island's "safe-staffing" law, which the General Assembly passed in 2021, established a similar formula but required slightly more daily hours of care for nursing home residents.

The coalition that pushed for the passage of the 2021 law applauded the federal mandate on Tuesday, but said they still want to see the Rhode Island law enforced.

RI nursing home industry says standards are 'unrealistic'

The nursing home industry, which strongly opposed Rhode Island's safe-staffing law, has similar objections to the new federal policy.

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“We are dismayed that the Biden administration is moving forward with this one-size-fits-all staffing mandate," John Gage, president and CEO of the Rhode Island Health Care Association, wrote in an email. "In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors across the country."

"When nursing homes can’t find these nurses and/or certified nursing assistants, they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need," he added.

Nationally, the nursing home workforce is down by 7.8%, Gage said. In Rhode Island, it's down 15.3%.

"Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers," he said, describing the federal rule as an "unfunded mandate."

Supporters still want 'enforcement of our own staffing standards'

Raise the Bar on Resident Care, which championed Rhode Island's 2021 staffing law and is made up of labor unions, community organizations and advocacy groups, praised the new federal requirements.

"Raise the Bar on Resident Care applauds the Biden administration for this historic step toward building a long-term care system that will deliver safe, dignified care to nursing home residents by improving staffing levels, investing in training and holding for-profit owners accountable for how they spend the nearly $100 billion annually from American taxpayers," a statement from the coalition said.

"Despite this momentous progress, Rhode Island nursing home residents and caregivers cannot afford to wait," the statement went on to say. "In the last three years, our state ranked second in the nation for serious nursing home deficiencies. We urgently need enforcement of our own staffing standards, which align with higher minimum-staffing standards recommended by experts."

The coalition is currently pushing the General Assembly to pass the Workforce Standards Board Bill, which would create a new board to oversee minimum pay and labor standards for nursing homes.

"We need a holistic solution now that brings together all stakeholders – employers, direct-care staff, residents and government representatives – to create a comprehensive plan addressing the root causes of the staffing crisis: low wages, poor training and high turnover," the group's statement concluded.

How the RI and federal staffing standards compare

Under the Biden administration's new mandate, nursing homes will be required to:

• Provide each resident with a minimum of 3.48 hours of nursing care per day
• That includes at least 0.55 hours of care from a registered nurse
• And 2.45 hours of care from a nurse assistant, according to the announcement.

Under Rhode Island's law, nursing homes were supposed to:

• Provide 3.81 hours of direct nursing care per day by January 2023
• Include 2.6 hours of care provided by a certified nurse assistant.

But the state Department of Health never fined any of the nursing homes that failed to meet the minimum-staffing standards, effectively rendering the law toothless. In December, Gov. Dan McKee suspended the penalties, citing "an unprecedented labor crisis."

Like the Rhode Island law, the federal rule is designed to be implemented in phases over the course of several years. It also includes a number of other requirements, like having a registered nurse on site at all times, and developing a plan to improve recruitment and retention.

"When facilities are understaffed, residents may go without basic necessities like baths, trips to the bathroom and meals – and it is less safe when residents have a medical emergency," a fact sheet from the White House states. "This rule will not only benefit residents and their families, it will also ensure that workers aren’t stretched too thin by having inadequate staff on site, which is currently a common reason for worker burnout and turnover."