SENATE 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

Rereferred House Committee on Ways & Means

Senate Committee on Ways & Means

Senate Hearing Date(s):April 3, 1987

Majority Report:  Do pass as amended.

      Signed by Senators McDermott, Chairman; Gaspard, Vice Chairman; Bluechel, Cantu, Craswell, Fleming, Lee, McDonald, Rasmussen, Rinehart, Talmadge, Vognild, Warnke, Williams, Wojahn.

Senate Staff:Suzanne Petersen (786-7715)

                  April 6, 1987

AS REPORTED BY COMMITTEE ON WAYS & MEANS, APRIL 3, 1987

BACKGROUND:

The wages and benefits paid to nursing home employees are low compared to those paid to workers in hospitals or entry level jobs in industries other than long term care.  The Department of Social and Health Services does not currently establish wage levels for nursing home employees, and wage increases made by a nursing home are included in the annual cost report for reimbursement the following year.

Improvements made to buildings and related physical plants by nursing homes are also reimbursed the following year, unless they are required by the department as a condition of licensure.

There is no provision in the current law for receivership actions involving nursing home operations.  Receivership involves the appointment by a court of a trustee to administer the facility in circumstances where danger has been posed to residents due to serious deficiencies in the provision of patient care.

DSHS has authority to levy civil fines not exceeding $1,000 for violations by nursing homes of patient care and operating standards.  Currently, there are no statutory penalties for repeat violations.

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

Nursing home certificate of need decisions are made by DSHS.

There are also no state standards on the number of employees required to assure quality nursing services.  Low staffing ratios may contribute to high staff turnover and adversely affect quality of care.

SUMMARY:

Nursing homes are required to pay a minimum wage to employees of $5.01 per hour, as of January 1, 1988, if the legislature appropriates funds to make the necessary wage adjustments prospectively.  DSHS is required to adjust nursing home rates for these enhancements to wages and benefits.  An "enhancement cost center" is established for this purpose and the funds may not be used for any other purpose.  Shifting of savings from the nursing services cost center is prohibited.

Nursing homes are authorized to receive a prospective rate adjustment for physical plant improvements if a local health planning agency and DSHS approve a plan based on assessment of the potential benefits to nursing home residents.

Nursing homes may obtain prospective reimbursement for staffing increases and DSHS is required to establish rules for reviewing requests for such payments. 

Procedures are established for placing into receivership nursing homes with chronic violations of care standards or other serious violations. 

The certificate of need process is amended to involve the Legislature in determination of nursing home bed need. 

Procedures for assessing civil penalties are strengthened.  Penalties for discrimination against Medicaid patients are increased.  Nursing home inspections shall be conducted without advance notice. 

Nursing assistants will not be assigned to provide care until they have demonstrated proficiency.  The House Health Care Committee will conduct an interim study of nursing home staffing levels.

SUMMARY OF PROPOSED SENATE AMENDMENT:

Nursing homes are required to pay minimum hourly wages if the Legislature appropriates money specifically for that purpose in the biennial appropriations act.  A specific minimum hourly wage is not established.

Shifting of savings from the food cost center is allowed only to cover deficits in the nursing services cost center.

DSHS is required to establish rules and criteria for reviewing requests by nursing homes for prospective rate adjustments for physical plant improvements.

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

Various technical changes are incorporated.

Fiscal Note:      available

Senate Committee - Testified: Charles Hawley, Washington Homes for the Aged; Hilke Faber, Resident Councils; Susan Johnson, SEIU; Norm Taylor, King County Ombudsmen; Mike Wills, DSHS; Glen Hudson, Washington Health Care Association