HOUSE BILL REPORT
ESHB 1864
As Amended by the Senate
BYHouse Committee on Health Care (originally sponsored by Representatives Day, Brooks, Braddock, D. Sommers, R. Meyers, Sprenkle, Cantwell, Morris, Scott, Wolfe, Vekich, Patrick, Chandler, Crane, Winsley, Dellwo, Brough, Wineberry, P. King, S. Wilson, Bowman, Kremen, Dorn, Schoon, Van Luven, Wood, R. King, Cooper, Doty, Todd, McLean and O'Brien)
Concerning quality of care in nursing homes.
House Committe on Health Care
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. (11)
Signed by Representatives Braddock, Chair; Day, Vice Chair; Brooks, Ranking Republican Member; Cantwell, Chandler, Morris, Prentice, Sommers, Sprenkle, Vekich and Wolfe.
House Staff:Antonio Sanchez (786-7383)
Rereferred House Committee on Appropriations
Majority Report: The substitute bill by Committee on Health Care as amended by Committee on Appropriations be substituted therefor and the substitute bill as amended do pass. (24)
Signed by Representatives Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Silver, Ranking Republican Member; Appelwick, Belcher, Bowman, Braddock, Brekke, Bristow, Dorn, Ebersole, Hine, May, McLean, Nealey, Peery, Rust, Sayan, Spanel, Sprenkle, Valle, Wang and Wineberry.
Minority Report: Do not pass. (1)
Signed by Representative Padden.
AS PASSED HOUSE MARCH 10, 1989
BACKGROUND:
During the last biennium a broad based coalition of nursing home professionals, long term care advocates, consumers, and health professionals identified several significant quality of care issues facing the nursing home industry. Their findings indicated the need for enhanced wages and increased formal training for direct care nursing staff and administrators. The wages paid for nursing home nursing staff is 16 to 30 percent behind what is currently being paid in hospitals. With fewer nurses willing to work in nursing homes, quality of care concerns have been raised. In addition, this condition has caused most nursing homes to turn to higher cost temporary health personnel agencies for assistance in staffing.
Less available licensed nursing staff in nursing homes has created a need for student and graduate nurses to utilize their professional training to the fullest extent possible. Supervised nursing students working and training in hospitals are currently allowed to provide medication to patients. This same professional privilege, however, is not available in nursing homes. Allowing qualified nursing students to provide medications to nursing home residents may help alleviate some of the problems occurring because of the nursing shortage.
Some nursing home residents require periodic hospitalization. Currently the residents may face the loss of their nursing home bed because there are no provisions in our nursing home reimbursement system to pay the nursing home to hold their bed while they are hospitalized. This problem is especially critical for patients in nursing homes with a very high rate of occupancy.
Increased numbers of highly debilitated nursing home residents needing nursing home long stay and short stay admissions may also be placing additional strain on the nursing home. Very little information, however, is available about the size, scope, and impact of heavy care patients in nursing homes.
SUMMARY:
A 12-1/2 percent increase for wages and benefits for nursing home nursing staff (RN, LPN) is requested with the qualification that funds are appropriated.
Graduate nurses and student nurses are permitted to administer medication to nursing home residents.
New rules are established for the Department of Aging and Adult Services to allow for denying a nursing home license to an applicant. Sanctions imposed for violation of federal regulations are also revised to allow the Department of Aging and Adult services to order immediate closure of the home and/or immediate transfer of residents if an emergency exists affecting the health or safety of residents. The department may deny payment for all Medicaid eligible individuals admitted after the nursing home has been cited for deficiencies and did not correct those deficiencies within three months, or if the home has been found in violation of standards of care on three consecutive surveys. Monetary penalties are also established.
The department is given the authority to impose due process rights for stop placement and emergency transfer in nursing homes.
The process of dealing with nursing homes in receivership status is changed to reflect a need to maintain the smooth functioning of the nursing home and protection of its residents during the transfer of the home.
Post survey charges of $12 per bed are assessed to the nursing home for those surveys requested by the facility after the second and subsequent post survey or visit.
If nursing homes are at or above a 92 percent rate of occupancy, they must reserve a medicaid patient's bed and reimburse the established medicaid reimbursement rate for the unoccupied bed.
Aging and Adult Services Administration is directed to conduct an evaluation of the dynamic needs of heavy care medicaid nursing home patients.
EFFECT OF SENATE AMENDMENTS: All language modifying the nursing services cost center and allowing the Department of Social and Health Services to provide for a 12 1/2 percent increase for wages and benefits for nursing home nursing staff was deleted. The 92 percent minimum occupancy lid and the five day bed hold for medicaid patients was eliminated. The Aging and Adult Services Administration study of the needs of heavy care medicaid nursing home patients was also eliminated. The Department of Social and Health Services, in cooperation with area agencies on aging, is mandated to provide and distribute printed materials on available long-term care services. Federally required language requiring the state to use money from the mental health budget to serve persons in need of active treatment in institutions for mental diseases is added.
Fiscal Note: Requested February 10, 1989.
House Committee ‑ Testified For: (Health Care) Hilke Faber, Washington State Nursing Home Residents Councils; Fred Mills, AARP; Kathy Marshall, Washington Association of Homes for the Aging; Glen Hudson, Washington Health Care Association; Patti Joynes, Washington State Nurses Association; Joan Matheson, Licensed Practical Nurses Association; Norm Taylor, Nursing Home Advisory Council and Rick Guthrie, Puget Sound Health Care Center.
(Appropriations) Glen Hudson, Washington Health Care Association; Hilke Faber, Washington State Nursing Home Residents Councils; Fred Mills, AARP; Patti Joynes, Washington State Nurses Association.
House Committee - Testified Against: (Health Care) Charles Reed, Department of Social and Health Services; Jane Boyajian, State Long Term Care Ombudsman and Jeanne Marie Thomas, Seattle King County Long Term Care Ombudsman.
(Appropriations) None Presented.
House Committee - Testimony For: (Health Care) Quality of care in nursing homes needs to be addressed at several specific levels. Most important is professional nursing staff and directors of nursing services. Assistants with increased wages and benefits will provide nursing homes with an opportunity to fairly compete against other segments of the health care industry for professional nursing staff. An added surcharge of $2.50 per bed with the funds going for resident councils will assist nursing homes by providing an added measure of client and family participation in quality of care.
(Appropriations) This legislation will provide wage increases for nurses if authorized in the biennial budget act. This will result in improved quality of care and lower nurse turnover.
House Committee - Testimony Against: (Health Care) A $2.50 bed surcharge should be distributed to local ombudsman programs rather than nursing home residents' councils.
(Appropriations) None Presented.
VOTE ON FINAL PASSAGE:
Yeas 96; Excused 2
Excused: Representatives Bowman and Hankins