THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

INTRODUCED BY WASHINGTON, FERLO, TARTAGLIONE, FONTANA AND KITCHEN, JANUARY 20, 2009

REFERRED TO PUBLIC HEALTH AND WELFARE, JANUARY 20, 2009  

AN ACT

Requiring long-term care nursing facilities to maintain certain

staffing levels in order to protect the health and safety of

residents and employees; providing for powers and duties of

the Department of Health; and imposing civil penalties.

The General Assembly finds and declares as follows:

(1)  The Commonwealth has a large and growing population

of senior and disabled persons who require nursing facility

care.

(2)  Significant staffing resources are necessary to

provide quality care to our senior and disabled citizens who

reside in nursing homes.

(3)  Long-term care nursing facilities which receive

public money should be required to provide at all times

staffing resources to meet the minimum levels necessary to

provide quality care to each resident.

(4)  Nursing facilities which receive public money have a

responsibility to report to residents, their families and the

taxpayers of this Commonwealth the staffing levels that they

provide for the residents in their care.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1.  Short title.

This act shall be known and may be cited as the Nursing Home

Staffing Level Act.

Section 2.  Definitions.

The following words and phrases when used in this act shall

have the meanings given to them in this section unless the

context clearly indicates otherwise:

"Acuity system."  An established measurement instrument

which:

(1)  Predicts direct care requirements for each

individual resident based on severity of resident illness,

need for specialized equipment and technology, intensity of

nursing interventions required and the complexity of clinical

nursing judgment needed to design, implement and evaluate a

resident's care plan.

(2)  Details the amount of direct care needed, both in

number of direct care nurses and skill mix of care personnel

required, on a daily basis, for each resident in a facility.

(3)  Is stated in terms that readily can be used and

understood by direct care staff.

(4)  Takes into consideration the resident care services

provided not only by registered nurses but also by licensed

practical nurses, nurse aides and other care personnel.

"Afternoon shift."  A shift commencing no earlier than 2 p.m.

and no later than 4 p.m.

"Assessment tool."  A measurement system which compares the

staffing level in a facility against actual resident care

requirements in order to review the accuracy of an acuity

system.

"Department."  The Department of Health of the Commonwealth.

"Facility."  A long-term care nursing facility.

"Licensed nurse."  A registered nurse or licensed practical

nurse.

"Morning shift."  A shift commencing no earlier than 6 a.m.

and no later than 8 a.m.

"Nighttime shift."  A shift commencing no earlier than 10

p.m. and no later than 12 midnight.

"Nurse aide."  An individual who provides nursing or nursing-

related services to residents in a facility. The term does not

include an individual who is a licensed health professional or

volunteers to provide such services without monetary

compensation.

"Shift."  A work period consisting of approximately eight

hours unless otherwise established under a collective bargaining

agreement.

Section 3.  Minimum staffing standards for nurse aides and

licensed nursing personnel.

(a)  General rule.--Beginning two years after the effective

date of this section, the department shall not issue or renew a

license of a facility unless that facility employs nursing

personnel sufficient in number as set forth in this section to

provide continuous 24-hour nursing care and service necessary to

meet the needs of each resident in the facility.

(b)  Minimum allocations.--

(1)  The ratios set forth in subsections (c) and (d)

shall constitute the minimum number of nurse aides and

licensed nurses to be allocated on each shift. Additional

nurse aides and licensed nurses shall be added and the ratio

adjusted to ensure adequate staffing of each shift and each

care unit in accordance with an approved acuity system.

(2)  Nothing in this section shall be construed to

preclude the department from establishing and requiring a

staffing plan to have higher staff-to-resident ratios than

those set forth in subsections (c) and (d).

(c)  Nurse aide ratios.--A facility shall maintain a ratio of

residents to nurse aides of no more than:

(1)  Eight to one during a morning shift.

(2)  Ten to one during an afternoon shift.

(3)  Fifteen to one during a nighttime shift.

(d)  Licensed nurse ratios.--A facility shall maintain a

ratio of residents to licensed nurses, either registered nurses

or licensed practical nurses, of no more than:

(1)  Fifteen to one during a morning shift.

(2)  Twenty-five to one during an afternoon shift.

(3)  Thirty-five to one during a nighttime shift.

(e)  Restrictions on nursing staff services.--No employee

designated as a member of the nursing staff shall provide the

following services:

(1)  Food preparation.

(2)  Housekeeping.

(3)  Laundry.

(4)  Maintenance.

(f)  Restrictions on other services.--A person employed to

provide the services under subsection (e) shall not provide

nursing care to residents and shall not be counted in

determining the ratios in subsections (c) and (d).

Section 4.  Facility implementation of acuity system.

A facility shall implement an acuity system within two years

of the effective date of this section in accordance with this

act and regulations promulgated under this act.

Section 5.  Public right to staffing information.

(a)  General rule.--A facility shall post for each care unit

of the facility and for each shift the current number of

licensed nurses and nurse aides directly responsible for

resident care and any other staff directly responsible for

resident care and the current ratios of residents to staff,

which show separately the number of residents to licensed nurses

and the number of residents to nurse aides.

(b)  Posting requirements.--The information shall be posted:

(1)  For the most recently concluded cost reporting

period in the form of average daily staffing ratios for that

period.

(2)  In a manner and form which is visible, easy to read

and to understand, and accessible to all residents, their

families, caregivers and potential consumers in the facility.

Section 6.  Enforcement.

(a)  Civil penalty for staffing violation.--The department

shall impose a civil penalty upon any facility that fails to

meet the staffing requirements set forth in section 3. The

penalty shall be imposed for each day on which the failure

occurs.

(b)  Amount of penalty.--The amount of penalty in subsection

(a) shall be determined as follows:

(1)  For deficiencies in staffing which constitute

immediate jeopardy as determined by the department to

resident health or safety and for repeat deficiencies when a

monetary penalty has been previously imposed, the amount of

the penalty shall be not less than $3,000 nor more than

$10,000 for each day of such failure.

(2)  For deficiencies in staffing which do not constitute

immediate jeopardy to resident health or safety, the amount

of the penalty shall be not less than $50 nor more than

$3,000 for each day of such failure.

(c)  Civil penalty for posting violation.--The department

shall impose a civil penalty upon any facility that fails to

meet the posting requirements set forth in section 5. The

penalty shall be in the amount of $100 for each day upon which

the facility fails to fully satisfy the posting requirements of

this act.

(d)  Legal presumption.--In addition to the penalty set forth

in subsections (a) and (b), in any action brought by or on

behalf of a resident of a facility, the resident's heirs, or

both, for negligent infliction of harm or lack of adequate care,

a failure to meet the staffing requirements of section 3 shall

be presumed a contributory cause of any injury sustained by a

resident.

Section 7.  Regulations.

The department shall promulgate rules and regulations

necessary to carry out this act, which shall include the

following:

(1)  Licensed nurse and nurse aide staff-to-resident

ratios.

(2)  Acuity system parameters to be met by a facility,

including, but not limited to, the following:

(i)  The assessment of resident acuity through the

minimum data set and other factors the department may

deem appropriate.

(ii)  The classification of facility residents by

specific categories based on the resource utilization

group system and other factors the department may deem

appropriate. In establishing the specific categories, the

department shall consider a separate assessment and

categorization methodology for special populations

including, but not limited to, residents with behavioral

health problems, Alzheimer's disease and developmental

disabilities.

(3)  The process for approval and monitoring compliance

of acuity systems. The regulations may include a system for

class approval of acuity systems.

(4)  An accessible and confidential system to report the

failure to comply with requirements of this act and public

access to information regarding reports of inspections,

results, deficiencies and corrections under this act.

(5)  Enforcement procedures.

Section 8.  Effective date.

This act shall take effect in 60 days.