Hearing of the Health Subcommittee of the House Ways and Means Committee - Trends in Nursing Home Ownership and Quality

Statement

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REP. MIKE THOMPSON (D-CA): Mr. Chairman, could I --

REP. STARK: Mr. Thompson.

REP. THOMPSON: Thank you, Mr. Chairman. I want to thank you for holding today's hearing.

I think our quality of care in nursing homes is something that's important to all of us. But I just want to state for the record, and would like to hear from you Mr. Chairman, if you would, I just think it's very important that this committee recognize that we share jurisdiction with another committee on this issue.

And one of the big -- you can't divorce the two issues of quality and the issues of pay in this discussion. And the reality is we look at one side of it, and the Commerce Committee has the Medicaid side of it.

And I think this committee needs to do everything we possibly can to make sure that we encourage our colleagues on the Commerce Committee to do a better job with the Medicaid component, that's a big problem in this whole debate.

And as long as there's going to be a need for these care homes, and believe me, there is going to be as long as we all keep getting older, and there are no other -- not you, Mr. Chairman --

REP. STARK: Okay.

(Laughter.)

REP. THOMPSON: And there are not other alternatives. This is a very, very important industry in our community and in our families. And we need to have a more holistic, I think, approach in how we deal with this. So I'd like to encourage you, Mr. Chairman, and Mr. Camp, the ranking member, to please use the power and force of this committee and all of its memberships to get our colleagues in the Commerce Committee to address this other side of the financial equation.

REP. STARK: Well, the gentleman's remarks are well taken. I have great fear of taking on the entire Michigan delegation, much less my ranking member or the chair of the Energy and Commerce Committee, all in one term of Congress. But I have been encouraging energy and commerce to do a better job for over 35 years. And I will continue to do that.

You are correct that we have a joint jurisdiction, and our reimbursement part is very small, but our concern, I think that is shared equally with energy and commerce, right now is the quality issue.

And what we can do there, and if it is indeed overall payment, I don't think although we are called on often to pay for other committee's legislative mandates, that we can address the issue as long as you raise it -- that we can have Medicare in the position of bailing out lower Medicaid payments.

I just would give you an example, I don't know how many states anybody could think of where Medicaid pays a physician, more than Medicare and there maybe a state, but I haven't heard of it lately.

Now, if we were going suddenly have to raise Medicare physician reimbursement to cover low payments by states, we could break the Medicare system in short order.

So while that jurisdictional problem will come up, and I am -- I think we should all be cognizant of it. I think we just have to go ahead based on our role for those Medicare beneficiaries who need these services and --

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REP. THOMPSON: Thank you, Mr. Chairman.

I want to pick up on the issue of the minimum standards in the staffing and relationship between staffing and quality of care. And I think a couple of you had mentioned that this was an issue in your statements.

I read recently a study; I think it was published earlier this year, stating that the nursing shortage would be about 350,000 across the country by the year 2020. And in California, there was another study that was just recently done, that says that in our state alone we're going to face a shortage of about 11,000 nurses over the next five years.

And in the nursing home industry, there are currently some 100 -- 100,000 RN and nurse-related positions that are open in facilities across the country. And they're open because they -- people that run those facilities can't find individuals to fill those positions.

So irrespective of how you come down on the issue of minimum standards or ratios, we're facing a pretty big shortage of nursing personnel. And if we're going to, I think, address the issue of quality care, we're going to have to figure out how to close that gap.

And I'd like to hear from the witnesses if you have any ideas as to what this committee can do to help to close that gap, and to address the workforce shortages as it pertains to nurses.

MS. HARRINGTON: Okay. I'd like to address that, coming from a school of nursing and having thought about this a lot. We've done studies of the relationship of staffing turnover and wages, and the main problem is the wages in nursing homes are too low, significantly lower than hospital wages. And that causes high turnover.

But the workload is the major factor that causes the turnover. If you don't have adequate staff, then the employees, the RNs, as well as the nursing assistants do not stay. And so we have to have adequate staffing levels. And if -- and that's the big problem. The -- it's a low pay, it's the reason we have the current vacancies.

Now there is the problem in the future, but if we don't address the working conditions, the wages right now, then we're not going to have nurses be willing to go into nursing in the future, and that's what's going to cause the shortage.

REP. THOMPSON: Again, it's not just in nursing homes, it's across the board shortage.

MS. HARRINGTON: The shortage is -- there is a shortage, but in nursing homes it's acute because they're paying such low wages. And there is -- there are about 300,000 nurses that don't work, and they don't work right now because the working conditions are not good.

REP. THOMPSON: What determines if it's an acute shortage and just a shortage? If I'm going into the hospital next month for a problem and there isn't an inadequate number of nurses, it's -- from my perspective it's pretty acute.

MS. HARRINGTON: Yeah, but you have to have a hospital, and a nursing home has to be willing to hire enough staff so that the nurses are willing to stay there and work. And that's what they're not doing right now.

REP. THOMPSON: So the workload and wages as you see it are the big issues?

MS. HARRINGTON: Those are the big issues.

REP. THOMPSON: And so any reduction in either side of the financial ledger for nursing homes, be it Medicaid or Medicare, is going to further impact us?

MS. HARRINGTON: Well, it already has, because nursing homes have already dropped the RN staffing by 25 percent. But that's -- we don't know where the money goes. It's not necessarily that they need money. It's that they need to be accountable for the money that Medicare has already given them for the staffing.

REP. THOMPSON: Anyone else --

MS. HARRINGTON: Right now they don't have to staff at the level that Medicare has paid them for.

REP. THOMPSON: Anyone else like to comment?

MR. JOHNSON: Yes. Representative, in my work with -- when I was director of the Medicaid Fraud Control Unit, I on a regular basis was present in nursing homes.

And one of the reasons that it's difficult to get nurses to stay there is because most of the patients are -- not most, but a lot of them are non-ambulatory. So I mean it's a very physically demanding position.

Also in some nursing homes, probably a lot of nursing homes, you have Alzheimer's units or you have persons that are suffering with dementia from whatever other reason, and they are very difficult to deal with. And so when you have opportunity to go work at a hospital in a hospital setting, with the things that you have to deal with normally on a daily basis versus the nursing home setting, and the hospital is paying significantly more, why would you go work at the nursing home?

And so it -- I agree that it's a matter of one -- money -- and I'm not saying that the nursing homes don't have the money to actually pay these people. If you want someone to do a job, if you want to properly staff, if you pay enough, the people will come.

So I'm not saying that they don't have enough money to pay. They may be willing -- they may be unwilling to reduce their profit margins to pay a significant or enough money to get the nurses to come. But also, the nurses --

REP. THOMPSON: Again, with all due respect, sir, there is a national nursing shortage not just in nursing homes, but across the board. So if you're going to make that argument, you have to make it across the board. And if the -- if there is one nursing job that's vacant and paying more with better working conditions, I don't care where it is, you're going to have -- you're going to create the situation that you're talking about.

But my question was more of a macro question. How do we deal with the overall nursing shortage so we can supply the nurses? Because as you stated in your testimony, there is a relation between staffing and quality of care. And it's not enough just to say you've got to pay more money. And my time has run out.

Thank you, Mr. Chairman.

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