Regulation Problems For Nursing Homes Are Explained

From left, Jeremy Rutter, Heritage Ministries lead administrator; state Sen. Cathy Young, R-Olean; Darius Kirstein, director of financial policy and analysis at Leading Age New York; and Ken Allison, policy analyst and data specialist at Leading Age New York, attend advocacy day for nursing homes at the state capitol. Submitted photo

Long-term care comes with its fair share of challenges, and the lead administrator of Heritage Ministries explained that the challenges nursing homes face in the modern day are mostly regulations imposed by federal and state government.

Jeremy Rutter, who is also an administrator at Heritage Park Rehab and Skilled Nursing, recently shared concerns for advocacy day in Albany regarding the amount of logistical regulations long-term care facilities must consider.

He’s on the board of directors for Leading Age New York, an advocacy group for long-term care.

Rutter said a nursing home case mix adjustment considered in the executive state budget would negatively impact long-term care facilities throughout the state. If the proposal goes unchallenged, Rutter said nursing homes in the state could lose up to $246 million annually.

“Sen. (Cathy) Young was … very receptive to hearing about the challenges we face,” Rutter said after meeting with her at advocacy day. “Heritage Ministries and the seniors living in Western New York are truly blessed to have representatives like (Assemblyman) Andy Goodell and Cathy Young (who) take the time to listen to and advocate for our seniors.”

Rutter spent a portion of his time during advocacy day with the Republican legislators in an effort discuss how nursing homes need proper Medicaid and state funding in order to serve residents with high acuity. The amount of regulations was also discussed.

“The nursing home industry in general is the second most regulated in the country behind nuclear power plants,” Rutter said.

In the past three years, Rutter said that federal regulations have provided the largest overhaul in long-term care since 1987. Some regulations further ensure the ethical and proper treatment of residents, but other regulations, Rutter said, just add to the load of paperwork employees must contend with when they could be providing direct care instead.

“It’s added a tremendous amount of regulations we have to comply with,” Rutter said.

“To me, it’s taking away time that we could be spending with residents.”

He also spoke of how long-term care has changed over the years. Rutter said the vision of the nursing home resident has changed and that residents typically require more direct care than in decades past.

“What you’re seeing now is actually subacute care,” said Rutter, speaking of how many residents need hospital-level care in long-term facilities like Heritage these days.

The push for more acute care in nursing homes has been responded to across the country as more acute patients have been taken in. Gone are the days, Rutter said, of when the majority of nursing home residents were older people who could mostly live and walk on their own despite minor disabilities. Dialysis, IVs and more care from registered nurses are often required.

Registered nurses at nursing homes will soon also have to have four-year bachelors degrees instead of two-year associates degrees. Currently employed nurses are expected to further their education within the next 10 years, regardless of whether they’ll receive work incentives to do so.

“We really promote trying to help people with education,” said Rutter, who said Heritage Ministries will be providing some financial assistance, from tuition reimbursement to stipends for time off, for nurses to return to school.

With more skilled and educated labor, an increase in pay may also occur, which will compound challenges already impacting the state’s nursing homes like the minimum wage increase.

“There’s a huge compression factor in nursing homes,” Rutter said.

Since there are numerous levels of staff in long-term care facilities, if the pay rises for some, the pay is expected to rise accordingly for every level of staff, including janitorial workers, nurses, office workers, management and so on.

“The sheer amount of regulations is overwhelming at times,” Rutter said.

The number of regulations and processes through which they are implemented is always changing, Rutter said. A new survey process will determine how approximately 250 federal regulations will be implemented.

“(The survey) is federally designed, but it’s actually conducted by state department health workers,” Rutter said. “It’s challenging to say the least.”

There are state and Occupational Safety and Health Administration regulations on top of federal ones. Rutter said that among these are some needed regulations that push for resident rights and other elements that truly affect care.

He still maintained that the majority of regulations are burdensome and don’t help improve the care of residents.

A patient-driven payment model for Medicare will also be making its debut in October. The current system pays for the most acute care, from nursing to physical therapy, but with the new system, documentation will vary drastically as it will require many work hours to understand and implement so that nursing homes get the same amount of money and residents get the same amount of care.

“There’s going to be very little change in reimbursement,” said Rutter, who emphasized the main challenge and drawback will be the time spent understanding a new system that replaces one that some think already worked. “There’s where the frustration comes.”

Rutter said the amount of regulations cut away at the importance of nursing homes and the relationships with residents that drive people to work at these facilities.