FINAL BILL REPORT

2SHB 1006

PARTIAL VETO

                                  C 476 L 87

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

Rereferred House Committee on Ways & Means

Senate Committee on Ways & Means

SYNOPSIS AS ENACTED

BACKGROUND:

The wages paid to nursing home employees are not regulated by the Department of Social and Health Services.  Most nursing home employees receive lower wages and benefits than comparable workers in hospitals or in entry level jobs in industry.  In some cases, the wages are lower than established minimum need standards for public assistance clients.  Turnover in nurse's aide positions is extremely high, up to 300 percent each year.  Because most nursing home care is provided by nurse's aides, this high turnover rate may affect the quality of care received by nursing home patients.

Nurse's aides must receive training within six months of their employment in nursing homes.  No other state standards for training and education have been established.  There are also no state standards for the number of employees that are needed in relation to patient acuity levels to assure quality nursing services.  Low staffing ratios place hardships on existing employees at a time when nursing homes are receiving heavier caseloads of more seriously ill and debilitated patients.  These conditions exacerbate the problems resulting from high staff turnover and low morale.

If a nursing home grants wage increases, those increases are included in the nursing home's annual cost report for reimbursement the following year.  Improvements that nursing homes make to buildings and related physical plants also are not reimbursed until the following year, unless the improvements are required by the department as a condition of licensure.

There is no statutory provision for placing nursing home operations into receivership.  In receivership, a court appoints a person, as a trustee or ministerial officer, to represent the court and all parties in interest.  The receiver's duties are to preserve and administer the facility in accordance with the law and in the interests of the residents.  A receiver might be appointed in cases in which serious deficiencies in the provision of patient care present a danger to the nursing home residents.

The department may levy civil fines not exceeding $1,000 against nursing homes that violate defined standards of patient care.  Nursing homes that commit repeat violations are not subject to any specific statutory provisions.  A $500 civil fine may be assessed against a nursing home for retaliating against a resident who reported a violation.  Fines may be paid in lump sum or installments.

SUMMARY:

Nursing homes are required to adjust and maintain a minimum hourly wage for nursing home employees 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 the purpose of adjusting rates and those funds may not be used for any other purpose.  The department is required to adopt rules providing for increased wage rates for nursing home staff.

Nursing homes may receive a prospective rate adjustment for improvements made to its building or related physical plant.  To receive the prospective rate adjustment, a local health planning agency and the department must approve a proposal based on a determination that 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.  The receiver may be appointed if there is a danger posed to residents because of deficiencies in the provision of patient care.  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, and are required to preserve the assets.  Receivers must apply funds to obligations and needs most directly related to patient care.  They are entitled to reasonable compensation set by the court from revenues.

Civil penalties of up to $3,000 may be assessed for violations of certain patient care standards.  Facilities must be given a prior opportunity 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 the deficiency.  A serious violation of patient care standards that is repeated within one year of the original citation constitutes a separate violation, subject to a penalty of up to $3,000.  The civil fine for retaliating against a resident or a person who reports a violation is increased from $500 to $3,000.  The department may require that fines be spent to ameliorate the deficiency violation.

The department is required to report to the legislature by December 31, 1987, on the effectiveness of fines.

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

Legislative review and approval of nursing home bed needs established by the State Health Coordinating Council in the State Health Plan is authorized.

VOTES ON FINAL PASSAGE:

      House 92   0

      Senate    46     0(Senate amended)

      House 95   0(House concurred)

EFFECTIVE:July 26, 1987

Partial Veto Summary:  The section which would require a legislative review of determinations of need for additional nursing home beds in the state is vetoed.  (See VETO MESSAGE)