The recent closure of a large skilled nursing facility in Missouri has led to a state bill that proposes minimum staffing levels for assisted living communities there and a requirement that assisted living providers report staffing data to the federal government.
Missouri HB 2740 was introduced last week by state Rep. Crystal Quade (D-Springfield), who announced the bill outside of a now-closed St. Louis SNF that displaced more than 170 residents and 180 workers in late December. During a news conference, Quade said she sought to close the loopholes in the industry and hold providers more accountable, according to KSDK. Quade is Missouri House minority leader and has entered the Democratic primary for the 2024 governor’s race.
The Missouri Assisted Living Association strongly opposes the legislation, which it said would lead to “unfortunate consequences,” including limiting access to services by many low- and middle-income older adults. MALA Executive Director Keith Sappington told McKnight’s Senior Living that state staffing regulations require assisted living providers to meet the needs of residents, including offering sufficient staffing levels. He said staffing levels are flexible to meet changing resident needs.
Another provision, he said, “compels the federal government to collect data” for assisted living communities that it doesn’t regulate or reimburse.
“State governments cannot compel federal regulations or requirements upon assisted living through state legislation,” Sappington said. “Furthermore, Missouri’s regulatory oversight of assisted living communities is effective and holds providers accountable for their actions.”
He added that state regulatory agencies also have authority to sanction assisted living communities up to and including license revocation in the most severe circumstances.
But he said the “most troubling provision” would require assisted living communities to have a professional nurse on staff, as well as round-the-clock nursing personnel at all communities.
“This would essentially turn assisted living communities into nursing homes and would be a strong deterrent for thousands of Missouri’s seniors who seek to receive assistance and personal care in non-medical, homelike settings that assisted living offers,” Sappington said. “The impracticality of finding nurse professionals to staff every assisted living community in the state are staffing and funding impossibilities.”
He said other healthcare sectors, including hospitals and nursing homes, also are struggling to find sufficient nursing professionals, and the shortage is growing worse.
“The cost to seniors to have unnecessary nursing services would drive most into rapidly spending down limited retirement funding and being forced into skilled nursing facilities at the cost to billions in state and federal Medicaid budgets,” Sappington said. “IF this provision passed, Missouri would be the only state in the country with such requirements and lead to thousands of Missourians having to go to other states to receive the care and services they desire.
Proponents of the bill said that long-term care facilities are being bought by “opportunistic business owners” and other out-of-state businesses that cut staff members to maximize profits, strip assets from facilities and move money to other businesses to the detriment of residents and workers, according to the news outlet.
“These new owners often routinely schedule far fewer staff than are needed to provide care in their homes, provide inadequate training, cut corners for health and safety, pay low wages, and regularly obstruct the rights of workers,” a news release from SEIU Healthcare Missouri read. “All of this leads to compromised care for residents.”
The bill would establish minimum staffing levels for assisted living communities, require a professional nurse to serve as a director of nursing, and designate a charge nurse to be on site around the clock. The proposal also would apply new federal reporting requirements to assisted living communities, requiring them to provide information about their direct care staffing — including agency and contract staffing — to the Centers for Medicare & Medicaid Services, even though CMS does not reimburse or regulate assisted living communities.
The proposal would exempt assisted living communities from the minimum staffing requirements if a “verifiable hardship” prevents the community from complying. Those hardships could include being located in areas with a low supply of healthcare workers, but communities would need to provide data on documented job vacancies, staffing plans and lack of financial resources.
Communities would have to disclose all owners, trustees and companies that provide administrative, clinical and financial services to them, including real estate investment trusts.
LeadingAge Missouri indicated that it is studying the bill and has not made a decision on whether to support or oppose the legislation.
See additional coverage in sister media brand McKnight’s Long-Term Care News, which covers skilled nursing.
