What is changing?

The Pennsylvania Department of Health has begun issuing a comprehensive update of the rules governing the state’s nursing homes.  According to Health Secretary Alison Beam the revisions are intended “to improve care for residents and working conditions for staff in nursing homes.”

A key element of the proposed new rules is an increase in minimum staffing levels. Current state rules only require facilities to provide residents with 2.7 hours of direct care daily. This is well below the 4.1 hours recommended by the federal government and various experts. Under the proposed rule facilities would be required to provide residents with at least 4.1 hours, an increase of 1.4 hours each day.

Who is affected?

When finalized, the new rules will apply to the 692 skilled nursing facilities that are licensed by the Pennsylvania Department of Health. Approximately 72,000 individuals reside in those facilities. Assisted Living Facilities and Personal Care Homes which typically serve residents with less acute health needs are regulated by the Department of Human Services and will not be affected by the new Department of Health regulations.

Industry protests

While increasing the required hours of direct care should logically improve the quality of care, the staffing ratio increase is not without controversy. According to Zach Shamberg, President of the Pennsylvania Health Care Association, a group representing long-term care facilities, the new rule is “out of touch.” In addition to raising costs, the staffing ratio increase would require facilities, already struggling to deal with employee shortages, to hire 7,000 additional staff.

Advocates for increased staffing don’t dispute the need for additional funding provided that funding goes to staffing, not profit.  They suggest that improved pay and other forms of staff support can increase the available work force and improve its quality.

When will changes be implemented?

At the end of July, the Department of Health published the first of 5 packages of its proposed rules. It will work its way through Pennsylvania’s regulatory process and undergo some changes. The other 4 packages will be rolled out over time and will cover issues such as change of ownership, staff development and infection control and prevention.

The Department will wait to submit the final-form regulations until all five packages have completed their regulatory review. “[We] are committed to getting the proposed updated regulations through the regulatory review process by the end of 2022,” said Secretary Beam

Additional Information

The first package of proposed regulations

CARIE comments on first package

Alzheimer’s Association comments on first package

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