HOUSE BILL REPORT

E2SHB 1006

BYHouse Committee on Ways & Means (originally sponsored by Representatives Day, Lewis, Bristow, Brooks, D. Sommers, Cantwell, Vekich, Lux, Sprenkle, Bumgarner, Locke, Silver, Grimm, Braddock, Taylor, Niemi, Rasmussen, Holm, Brekke, K. Wilson, Dellwo, Winsley, Cole, Ebersole, Crane, Ballard, Doty, Heavey, Allen, Jacobsen, Holland, Scott, Rayburn, Sanders, Jesernig, R. King, Brough, P. King, May, Moyer, Spanel, Wineberry, Schoon and Ferguson)

Changing provisions relating to nursing homes.

House Committe on Health Care

Majority Report:  The substitute bill be substituted therefor and the substitute bill do pass.  (9)

      Signed by Representatives Braddock, Chair; Day, Vice Chair; Bristow, Brooks, Bumgarner, Cantwell, Lewis, D. Sommers and Sprenkle.

House Staff:John Welsh (786-7133)

Rereferred House Committee on Ways & Means

Majority Report:  The second substitute bill be substituted therefor and the second substitute bill do pass.  (31)

      Signed by Representatives Grimm, Chair; Bristow, Vice Chair; Allen, Appelwick, Basich, Belcher, Braddock, Brekke, Ebersole, Fuhrman, Grant, Hine, Holland, Locke, Madsen, McLean, McMullen, Nealey , Niemi, Peery, Rust, Sayan, Schoon, Silver, L. Smith, H. Sommers, Sprenkle, Taylor, Valle, B. Williams and Winsley.

House Staff:      Dave Knutson (786-7146)

AS PASSED HOUSE MARCH 13, 1987

BACKGROUND:

The wages and benefits paid to nursing home employees are lower than those paid to comparable workers in hospitals or entry level jobs in industry and in some cases, even lower than minimum need standards for public assistance clients.  The turnover of nurse's aides, who provide the majority of care in nursing homes, runs up to 300 percent yearly, which may affect quality of care.  The Department of Social and Health Services does not currently establish wage levels of nursing home employees, and any wage increases made by a nursing home are included in their annual cost report for reimbursement the following year.

Improvements made to building and related physical plant by nursing homes are not reimbursed until the following year, unless they are required by the department as a condition of licensure.

The costs of laundry services are deducted from the patient's $36 monthly personal needs allowance.

There is no provision in the law for receivership actions involving nursing homes operations.  Receivership involves the appointment by a court of a person, as a trustee or ministerial officer representing the court and all parties in interest, to preserve and administer the facility in accordance with the law and in the interests of the residents, under circumstances where there is danger posed to residents due to serious deficiencies in the provision of patient care.

The department currently has authority to levy civil fines not exceeding $1,000 for violations by nursing homes of patient and operating standards of care as defined by law.

Currently, there are no statutory provisions for repeat violations committed by nursing homes.  The civil fine for retaliating against a resident for reporting a violation is $500.  Fines may be paid in either lump sum or installments.

Nursing aides are to receive training within six months of their employment in nursing homes.  There are currently no other state standards for training and education.

There are also no state standards on the number of employees required to assure quality nursing services based on patient acuity levels.  Nursing homes are receiving heavier caseloads of more seriously ill and debilitated patients, and low staffing ratios place hardship on existing employees exacerbating the high staff turnover and low morale.

SUMMARY:

Nursing homes are required to adjust and maintain a minimum wage for nursing home employees at $5.01 per hour, as of January 1, 1988 if the legislature appropriates the funds.  The Department of Social and Health Services is required, in turn, to adjust rates to nursing homes for these enhancements to wages and benefits.  An "enhancement cost center" is established for this purpose and those funds may not be used for any other purpose.  The department is required to adopt rules providing for increased rates for nursing home staff.

Nursing homes are authorized to receive a prospective rate adjustment for improvements made to its building or related physical plant, if a local health planning agency and the Department of Social and Health Services have received and approved a proposal on the basis of whether the improvement better serves the needs of nursing home residents.

A procedure is established for the department to petition the superior court to appoint, on a temporary basis, a receiver to operate a nursing home under circumstances where there is a danger posed to residents due to services deficiencies in the provision of patient care.  Receivership involves the appointment by a court of a person as a representative of the court and trustee for all parties in interest to preserve and administer the facility.  The court is granted broad discretion to determine the duration and conditions of receivership.  Receivers are given full authority to operate the facility including staff changes and control of operating revenues, but must preserve the assets.  Receivers must apply funds to obligations and needs most directly related to patient care and are entitled to reasonable compensation from revenues set by the court.

Civil penalties of up to $3,000 for violations of certain patient care standards are provided for with a prior opportunity for the facility to correct the deficiency before being assessed.  If the violation is serious or jeopardizes the facility's ability to provide care, the penalty may be assessed without the opportunity to correct.  Serious deficiencies from patient care standards which are repeated within one year of the original citation constitute a separate penalty up to $3,000.  The civil fine for retaliating against a resident or person who reports violations is increased from $500 to $3,000.

The department is to report by December 31, 1987 to the legislature on circumstances relating to the effectiveness of fines.  Fines may be required by the department to be spent on ameliorating the deficiency violation.

The House Committee on Health Care is to conduct a study on staffing levels in nursing homes, considering levels of patient acuity and requirements in other states, and include requirements for education and training of nursing assistants.  The committee recommendations are to be made prior to the 1988 legislative session.

Legislative approval of nursing home certificate of need authorizations is established.

EFFECT OF SENATE AMENDMENT(S):   Nursing homes are required to pay minimum hourly wages if the legislature appropriates money specifically for that purpose in the biennial appropriations act.  The specific minimum hourly wage of $5.01 is not established.

DSHS is required to establish rules and criteria for reviewing requests by nursing homes for prospective rate adjustments for physical plant improvements.  Local health system agency review is removed from the process.

The civil penalty for violations of nursing home standards and regulations from $1,000 to $3,000 is referenced throughout.

The State Health Coordinating Council shall determine the total need for nursing home beds in the state in the second year of the biennium, unless the legislature makes the determination.

Various technical changes are incorporated.

Fiscal Note:      Attached.

House Committee ‑ Testified For:    (Health Care)  Representative Vekich, prime sponsor; Hilke Faber, Washington State Nursing Home President Councils; Charles Hawley, Washington Association of Homes for the Aging; Norm Taylor, King County Ombudsman, Sister Sharon Park, Senior Citizens Lobby; Fred Mills, American Association of Retired Persons; Steve Maag, Washington Health Care Association; and Frank Winslow, Alzheimer's Society.

(Ways & Means)  Fred Mills, Hilke Faber, Susan Johnson, Glen Hudson, Sister Sharon Park.

House Committee - Testified Against:      (Health Care)  None Presented.

(Ways & Means)  None Presented.

House Committee - Testimony For:    (Health Care)  The quality of care in nursing homes is adversely affected by the extremely high turnover rate of employees.  The work is very hard and often nursing homes are understaffed.  Employees receive training only on the job.  There is a real need to stabilize nursing home employment by providing for wage increases to at least $5.01 per hour, providing adequate training prior to employment and setting staff ratios to patients depending on their level of acuity.  Too often, laundry charges eat up the $36 monthly allowance of patients and this should be included in the overhead expenses.  Many nursing homes are old, and are in dire need of remodeling.  The living environment is also important to a patient.  Nursing homes should be able to remodel without the year's delay in reimbursement.  Receivership is important in situations where homes may be operating with serious deficiencies in patient care standards, putting residents at risk.  The transfer of those patients may cause further jeopardy.  Meaningful sanctions are needed to assure maintenance of standards.

(Ways & Means)  A higher wage for nursing home employees will reduce turnover and improve the quality of care.  a process to place nursing homes in receivership is needed.

House Committee - Testimony Against:      (Health Care)  None Presented.

(Ways & Means)  None Presented.

VOTE ON FINAL PASSAGE:

      Yeas 92; Nays 0; Absent 0; Excused 5

Absent:     Representative Chandler

Excused:    Representatives Doty, Hankins, Nealey, Sayan and B. Williams