The MNA was among the organizations invited to testify at hearings held at a Waltham senior center by the Joint Committee on Health Care regarding the issue of abuse and neglect of nursing home patients in Massachusetts. The hearings were held in the wake of an increase in the number of reports of elder abuse and neglect by the state DPH, which documented more than 12,000 complaints of poor care last year.
MNA executive director Julie Pinkham delivered the testimony, which included an extensive summary of recent research detailing the link between declining quality and safety of care in nursing homes and poor RN staffing, excessive turnover of all nursing staff and poor pay and working conditions, particularly for nurses aides.
Pinkham highlighted the following statements as taken from a 2001 study conducted by researchers associated with the John F. Kennedy School of Government:
- "Strong evidence supports the relationship between increases in nurse staffing ratios and avoidance of critical quality of care problems."
- "The rate of turnover among nursing staff in long-term care institutions is extremely high, averaging 100 percent for certified nursing assistants and 66 percent for registered and licensed nurses."
- "A 1999 General Accounting Office (GAO) report noted that each year, more than one fourth of nursing homes had deficiencies that either caused actual harm to residents or placed them at risk of death or serious injury."
Pinkham also pointed to a report by the Institute of Medicine in 2003, which found that nine in 10 nursing homes in America were understaffed, and that this understaffing was causing a rapid decline in the quality of care for nursing home residents.
"Here in Massachusetts, our nursing home industry is providing a level of poor care in line with these national findings,” she told the committee. “We have received reports from nurses and patients of staffing levels in nursing homes in our state that leave one nurse responsible for as many as 40 to 60 patients at a time. We have received hundreds of complaints of poor care, serious accidents, terrible neglect and patient abuse as a result of these conditions."
Pinkham added, "As with the hospital industry, the nursing home industry has failed to provide nurses and nurses aides with the support and resources they need to practice their profession and to deliver the care patients deserve."
In both cases, the MNA told the committee that legislation to regulate staffing levels was needed.
But Pinkham cautioned that while in the hospital industry, RN-to-patient ratios alone would solve the problems of quality and safety in that setting, in the long-term care sector the problems are more complex.
"While salary issues are not a primary issue of concern in hospitals, they are in nursing homes. There is a real danger that if you pass ratio legislation for long-term care without providing the funding base necessary to recruit and retain staff to fill those positions, you will not solve the crisis we now face."
She pointed out that the issue of adequate pay, particularly for nurses’ aides, as well as for LPNs and RNs is of paramount importance to this issue. "We have nurses’ aides being paid poverty wages, working under horrendous conditions, which is a recipe for the ludicrous turnover rate they are now experiencing," Pinkham stated.
Therefore, solving the crisis in long-term care requires a more comprehensive approach. The MNA made the following recommendations to address the problem:
- Significant increases in state and federal funding for long-term care, that includes direct-wage pass throughs to guarantee a living wage for nurses’ aides, and a competitive wage for LPNs and RNs.
- Other supports for direct care workers, including welfare-to-work training programs, child care and transportation supports are also necessary.
- We also need to ensure all these workers have greater access to union organizing and collective bargaining so that they can have the leverage to negotiate for fair wages and benefits, and to have a protected voice in advocating for working conditions to ensure adequate care.
"Finally, as a society and a culture we need to recognize the value of care giving and to provide funding and resources to encourage those in our society to enter and stay in this important field of work. We also need to provide those who need this type of care with a system that works—one that is focused on treating the elderly and those with chronic conditions with dignity and respect," Pinkham concluded.
