Family caregiver with disabled elderly man

Minimum staffing ratios would be established for assisted living communities with memory care units under a bill being considered by Oregon lawmakers.

SB714 would require the state Department of Human Services to develop an acuity-based staffing tool to evaluate whether an assisted living community, residential care facility or other long-term care facility with a memory care unit has sufficient staffing and to assess the number of direct care staff hours required to meet resident needs.

Libby Batlan, senior vice president of government relations for the Oregon Health Care Association, told McKnight’s Senior Living that SB714 as originally written “would not move the needle forward on quality.”

“OHCA is opposed to the base bill version of Oregon SB714, which proposed fundamentally shifting Oregon’s approach to staffing in community-based settings,” Batlan said, adding that the state’s current approach to staffing is aligned with national best practices of staffing to the individualized care and service needs of residents by facility. “There are currently not enough qualified and trained caregivers in Oregon to meet the original requirements of SB714,” she said.

Batlan said that OHCA is working with the bill’s proponents and lawmakers to evaluate other unintended and harmful consequences of the measure.

“Policy changes to staffing level requirements in facilities cannot and should not be had without also addressing the broader workforce challenges of the long-term care sector,” she said. “We would be very supportive of a comprehensive approach that leverages strategic initiatives and investments in the sector to help providers recruit, train and retain high quality caregivers, particularly in the wake of a global pandemic with unique impacts to long-term care.”

LeadingAge Oregon also does not support the bill, the organization’s CEO, Ruth Gulyas, said in testimony about the bill. Regulatory oversight, enforcement mechanisms and quality improvement tools already exist to ensure sufficient staffing levels, she said, and state rules governing assisted living and residential care facilities already require facilities to have adequate direct care staff present at all times to meet the changing physical or mental needs of residents.

In 2017, Oregon adopted legislation designed to improve care, training and services to residents in long-term care facilities, including the development of an acuity-based staffing tool. Efforts to improve and test the tool were put on hold due to the pandemic. 

“The pandemic has challenged all Oregonians. Long-term care caregivers and providers have been at the forefront of the pandemic doing their best every day to keep seniors safe amongst the ever changing landscape,” Gulyas testified. “COVID-19 has exacerbated an existing staffing challenge in long-term care.”

Gulyas said the state should use its existing authority to monitor, evaluate and work with providers to assure adequate staffing at assisted living communities, residential care facilities and memory care communities. 

More than 550 assisted living, residential care and memory care communities provided care to about 24,000 Oregon residents in 2020, according to testimony from the Institute on Aging at Portland State University. Although the institute supports using data to determine staffing levels, representatives testified that staff availability, retention, training and continuing education are key components of quality care delivery to older adults and people with disabilities.

They also noted that assisted living communities compete for a limited number of workers with residential care facilities, nursing homes, adult foster homes, group homes and home care agencies. 

“Given the unique needs of the [assisted living / residential care] and [memory care] populations across different regions of Oregon, it is imperative that this legislation provides flexibility and support for AL/RC communities to determine staffing levels in a way that minimizes administrative burden,” according to testimony from the Institute on Aging. “Addressing workforce and staffing challenges will be hard work, requiring multiple interventions developed in partnership with AL/RC operators, staff, residents and residents’ families.”

The Service Employees International Union supports SB714 and SB703. SB703 would require the Department of Human Services and the Oregon Health Authority to adopt quality metrics for caregiver registries, home health agencies, in-home care agencies and certain residential care facilities.

A work session on SB714 is scheduled for today.