The United States government can pass and enforce laws and promulgate rules and regulations pertaining to all types of healthcare where federal dollars or other grounds for jurisdiction exist. This includes in nursing homes and long-term care facilities. Commonly healthcare providers that take federal dollars through programs like Medicare and Medicaid will be obligated to follow federal rules in order to be eligible for reimbursements for care and treatment they give to patients and residents insured by these federal programs.
As the New York Times recounted recently, in 1987 the U.S. Congress considered a proposed bill that would have required all nursing homes to have a registered nurse on the facility premises for eight hours per day. This requirement was irrespective of how big the facility was or how many patients there were. Unfortunately has many know, bills pass through Congress after numerous compromises, and regulations allowing for reduced staff sizes at nursing homes was one of those compromises. Thus in an environment where any conceivable type of emergency could occur, a registered nurse would be around only for one third of the day, with lesser trained staff around the rest of those 24 hours.
This is consistent with the general trend of nursing homes looking to reduce the number of staff members, including registered nurses, nurses, nurses’ aides, and whoever else, who are on call. By reducing staff as much as possible, these facilities save on salaries or wages, and those homes can therefore reduce overhead and increase profits. Thus the bottom line can be more important to nursing home administrators and managers than the health of a facility’s patients.
New Bill Introduced
Now, Illinois Congresswoman Jan Schakowsky has introduced a bill called the “Put A Registered Nurse in the Nursing Home Act” (H.R. 5373). Representative Schakowsky’s bill would require that all nursing home facilities that receive reimbursement from Medicare or Medicaid, which now amount to roughly 16,000 across the country according to the Times article, must have a “direct care registered nurse” on call at each facility at all times.
As reported, 13 states already require a registered nurse to be on staff at nursing homes in some way or another, typically depending on the amount of patients around at a given time. Only a handful require 24/7 coverage no matter what, which is what H.R.5373 seeks to fix. This is also not to say that none of the nursing homes receiving federal dollars have round-the-clock registered nurses. A substantial number do, but far too many do not. And according to the article in citing the Bureau of Labor statistics, the cost of having at least one registered nurse on the clock at any time is not prohibitively expensive for nursing homes. Furthermore, many nursing homes reap tremendous profits from federal programs like Medicare and Medicaid, and would likely not want to see that money float away over the mere added cost of employing a registered nurse 24/7.
Requiring the presence of a registered nurse 24/7 in every home will provide a trained nurse who can handle the emergencies that occur morning, noon and night. Having more registered nurses can also ensure a more watchful eye over patients to ensure that they rest comfortably and are not subject to things like bed sores or infections. This is not a promise to fix all problems plaguing facilities, but is a step in the right direction.
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