>> EARLIER THIS WEEK, VICE PRESIDENT KAMALA HARRIS WAS IN
LaCROSSE TO INTRODUCE NEW FEDERAL STANDARDS FOR NURSING
HOMES IN LONG-TERM CARE FACILITIES.
ONCE FINALIZED, THE NEW RULES WOULD IMPLEMENT A MINIMUM NUMBER
OF HOURS STAFF WOULD HAVE TO BE AROUND PATIENTS AND REQUIRE A
REGISTERED NURSE ON-SITE AT ALL TIMES.
MEDICAID REIMBURSEMENT GO TOWARDS EMPLOYEE WAGES.
VICE PRESIDENT HARRIS NOTED MANY OF THE WORKERS IN THIS INDUSTRY
HAVE BEEN TRADITIONALLY UNDERPAID, A FACTOR THAT LEADS
TO STAFFING SHORTAGES. >> ONE OF THE CHARACTER TRAITS
OF REAL LEADERS IS TO HAVE SOME LEVEL OF COMPASSION AND CONCERN
ABOUT THE SUFFERING OF OTHER PEOPLE AND THEN WANT TO DO
SOMETHING ABOUT THAT TO IMPROVE THEIR CONDITION.
THAT'S THE WORK OF THESE WORKERS THAT WE'RE TALKING ABOUT RIGHT
NOW. AND WE AS A SOCIETY SHOULD VALUE
THAT. >> CURRENT LAW ONLY SAYS
FACILITIES NEED TO HAVE, QUOTE, SUFFICIENT STAFFING.
MEET THESE NEW STANDARDS, THE GOVERNMENT SAYS A MAJORITY OF
THE COUNTRY'S 15,000 NURSING HOMES WOULD NEED TO ADD STAFF IN
ORDER TO COME INTO COMPLIANCE. TO GIVE US THE WISCONSIN
PERSPECTIVE, WE ARE JOINED BY RICK ABRAMS, THE EXECUTIVE
DIRECTOR OF THE WISCONSIN HEALTHCARE ASSOCIATION AND THE
WISCONSIN CENTER FOR ASSISTED LIVING.
>> ZAC, IT'S A PLEASURE TO BE HERE.
THE LONG-TERM CARE INDUSTRY IS IN WISCONSIN.
ARE THERE ENOUGH BEDS AND WORKERS TO PROVIDE FOR A
GENERATION OF AGING BABY BOOMERS?
THERE ARE ENOUGH BEDS. WE HAVE GOT APPROXIMATELY 26,000
NURSING HOME BEDS IN THE STATE. OUR AVERAGE STATEWIDE OCCUPANCY
IS ABOUT 70%, SO YOU'VE GOT CAPACITY, BUT THE CHALLENGE IS
DEDICATED WORKERS. THE LABOR SHORTAGE WAS ALWAYS A
PROBLEM IN WISCONSIN. CERTAINLY WAS EXACERBATED WITH
THE PANDEMIC. AND FROM OUR PERSPECTIVE, AND
I'M SURE WE'LL TALK MORE ABOUT IT, A COOKIE CUTTER BLACK AND
WHITE STAFFING MINIMUM JUST IS NOT THE RIGHT APPROACH.
>> SO, YEAH, LET'S TALK ABOUT. WHAT IS YOUR REACTION FOR THE
NEW REGULATIONS? ARE THERE ANY PARTICULAR THAT
SEEM MORE ONEROUS OR DIFFICULT FOR NURSING HOMES AND LONG-TERM
CARE FACILITIES TO ACTUALLY MEET?
>> YOU KNOW, ZAC, TWO THINGS. FIRST, EVEN THOUGH WE MAY
DISAGREE WITH THE APPROACH, THERE'S NO QUESTION THAT
EVERYONE IS WELL-INTENTIONED, WHETHER YOU'RE A FEDERAL POLICY
MAKER LIKE OUR VICE PRESIDENT IS, STATE POLICY-MAKER, AND
CERTAINLY THE FOLKS IN THE SECTOR, BUT WHEN YOU LOOK AT THE
REQUIREMENTS OF THE MINIMUM STAFFING MANDATE, THE MOST
DIFFICULT TO MEET IS GOING TO BE THE REQUIREMENT OF HAVING A
REGISTERED NURSE, AN R.N., IF YOU WILL, ON-SITE 24 HOURS A
DAY, SEVEN DAYS A WEEK. THAT'S GOING TO BE DIFFICULT, IF
NOT IMPOSSIBLE IN SOME CASES TO MEET SIMPLY BECAUSE THERE ARE
NOT ENOUGH R.N.s, BUT EQUALLY CONCERNING TO US IS THAT THAT
24/7 REQUIREMENT, IF YOU WILL, APPLIES WHETHER YOU'RE A 40-BED
NURSING FACILITY IN RURAL WISCONSIN OR A 500-BED NURSING
FACILITY IN BRONX, NEW YORK. THAT JUST DOESN'T MAKE SENSE TO
US. APPROACH.
>> SO I WANT TO READ A STATEMENT WE RECEIVED FROM KIM MARHEINE.
SHE SAYS MANY ASK WHETHER THE TIME IS RIGHT FOR THESE CHANGES,
GIVEN CURRENT STAFFING STRESSORS FACING THE LONG-TERM CARE
INDUSTRY. THOUGH THERE MAY NEVER BE A BEST
TIME FOR THESE CHANGES, CONSUMER NEEDS AND EXPECTATIONS DEMAND
THE TIME IS NOW. WHAT'S YOUR RESPONSE TO THAT
STATEMENT? >> WELL, FIRST, I HAVE GREAT
RESPECT FOR KIM. I GOT MY START IN LONG-TERM CARE
AS A LONG-TERM CARE OMBUDSMAN. BUT, YOU KNOW, ZAC, IN THE
BEGINNING, IN YOUR INTRODUCTION, YOU TALKED ABOUT THE CURRENT
STANDARD, AND THE CURRENT STANDARD IS SUFFICIENCY.
NOT ONLY IN NUMBERS, BUT ALSO IN EXPERTISE, AND WE THINK THAT
THAT IS THE RIGHT APPROACH, BECAUSE EVERY NURSING HOME, NOT
ONLY IN THE STATE OF WISCONSIN, BUT LITERALLY EVERY NURSING HOME
IN THIS COUNTRY HAS A DIFFERENT PATIENT MIX.
TO STAFF TO THAT PATIENT MIX. AND WE THINK THAT THAT'S THE
RIGHT APPROACH. NURSING HOMES CLOSING DOWN?
WILL THEY JUST NOT BE ABLE TO ACCEPT PEOPLE?
WHAT'S THE BIGGER IMPLICATION, ESPECIALLY IN RURAL WISCONSIN?
>> YOU KNOW, I THINK THERE'S THREE IMPLICATIONS, TWO OF WHICH
YOU'VE ADDRESSED. RURAL AREAS FOR OUR SMALL
COMMUNITY-BASED FACILITIES, THEY MAY NEED TO -- THEY MAY NEED TO
CLOSE IF THEY CANNOT MEET THESE STANDARDS, BECAUSE NOT MEETING
THE STANDARDS THEN CARRIES WITH IT SUBSTANTIAL PENALTIES, AND A
FACILITY CAN'T SUSTAIN THAT. BUT, YOU KNOW, IF A FACILITY
FINDS THAT AFTER A GOOD FAITH EFFORT THEY JUST CANNOT STAFF TO
THE REQUIREMENT, THEY'RE GOING TO THEN REDUCE THE NUMBER OF
BEDS THAT ARE OCCUPIED. AND WHEN THAT HAPPENS,
ESPECIALLY IN RURAL AREAS, ACCESS IS CHALLENGED, AND NOBODY
WANTS THAT TO HAPPEN. BUT YOU KNOW, ZAC, THE THIRD
THING, AND THIS IS PURELY FROM MY PERSPECTIVE, IS THAT IF A
FACILITY CANNOT ACHIEVE THE 3.48 HOURS PER RESIDENT DAY, IF
THEY'RE NOT IN A POSITION TO REDUCE THE NUMBER OF OCCUPIED
BEDS, WHAT THAT DOES IS IT PUTS MORE PRESSURE ON THE STAFF THAT
IS THERE AND THE BIGGEST CONCERN THAT I HAVE WITH THAT IS THAT
THAT IS GOING TO HASTEN BURN-OUT AND THAT IS GOING TO HASTEN THE
EXODUS OF THESE GOOD AND DEDICATED PEOPLE FROM OUR
SECTOR, AND NOBODY CAN AFFORD THAT.
QUESTION WAS EXCELLENT. AND FOR ONE, TWO, OR ALL THREE
OF THESE REASONS, WE JUST DON'T THINK A BLACK AND WHITE COOKIE
CUTTER, MINIMUM STAFFING STANDARD IS GOOD.