NJ Must Bring Safe Staffing Levels to Nursing Homes

May 29, 2018

By State Sen. Brian P. Stack and Milly Silva

To send an aging parent or loved one to live in a nursing homes is a difficult, often heart-wrenching decision. It is self-evident why most seniors' first preference is to remain at home for as long as possible, to be cared for by family or a professional caregiver in a familiar, loving environment. Yet there often comes a time in life, due to declining health or the lack of an available family caregiver, when seeking 24/7 care at skilled nursing facility becomes the last, best option.

As baby boomers retire in unprecedented numbers, it in incumbent that New Jersey has an adequate system of oversight and safety standards to protect the wellbeing of our state's 44,000 nursing home residents. Yet in key respects, New Jersey's nursing home industry is failing these patients and the healthcare workers tasked with their daily care. As an industry which receives most of its revenue from public sources--Medicaid and Medicare--nursing homes have an obligation to use this funding to directly improve care at the bedside.

Experienced caregivers are the foundation of quality care. Without sufficient staff, no amount of money can ensure that nursing home patients receive the compassionate, personal attention they need throughout the day. Yet despite New Jersey nursing homes being among costliest in the nation, our nursing homes rank 44th overall for certified nursing assistant (CNA) staffing hours per patient, according to data Centers from Medicare & Medicaid Services.

This is a concern which requires urgent attention. CNAs are the primary direct-care workforce in nursing homes. They are the individuals responsible for assisting patients will all their daily living needs--feeding, dressing, bathing, toileting, as well as providing general emotional support and friendship to those who are lonely and who may rarely, if ever, receive visitors of their own.

Speak to just about any CNA, and stories will abound about times when they were totally overwhelmed by deficient staffing levels.

Tyshara Bonaparte, who works at a Jersey City nursing home, says that recently she was the sole CNA caring for 24 patients during her 7 a.m. to 3 p.m. shift, the busiest time of the day.

"What am I supposed to do when I have to attend to the needs of two dozen patients, all at once? It is so unfair for them to have to wait to start their day, to delay breakfast or sit in a soiled diaper. I put on a smile and do my best to make them comfortable, but things are not okay," she says.

Josefina Jimenez, a CNA from Passaic, recalls that "one night I was the only CNA on a floor with 50 residents. I knew that one of my residents was close to dying, and I wanted to comfort her in her final moments because she did not have anyone else to be there with her. But I was so overwhelmed with my other responsibilities that by the time I made it to her room she had already passed away. It was heartbreaking."

When there aren't enough direct care staff, it bottlenecks other critical work. "If CNAs are working short, it interferes with my nursing duties," says Miriam Douglas, a licensed practical nurse in East Orange. "When residents aren't washed or fed in a timely manner, it takes time out of our day when we need to be administering medication to patients. It disrupts our priorities and ultimately it's the residents who suffer."

Stories like these are commonplace in nursing homes. But they don't have to be. Legislation (S1612/A382) has been introduced that would require nursing homes to meet basic minimum staffing ratios on a shift-by-shift basis: 8 patients per CNA on the morning shift, 10 patients per CNA in the afternoon, and 16 patients per CNA overnight. This is a commonsense and straightforward approach to making sure that poorly-performing facilities raise their staffing levels to an adequate number. It empowers patients, their families and caregivers to understand how their facility compares to a clear standard, and to know when CNAs are working short at any given time.

We owe it to our state's seniors to pass this law in the current legislative cycle. The stakes of inaction are too high for the tens of thousands of vulnerable people who depend on the type of round-the-clock care that only nursing homes can provide. This is a fight we can, and must, win.


(Sen. Brian P. Stack represents New Jersey's 33rd Legislative District. Milly Silva serves as Executive Vice President of 1199SEIU United Healthcare Workers East)