Advocates push for mandatory minimum nurse staffing ratios at Illinois hospitals


The Illinois Health and Hospital Association, the Association of Safety Net Community Hospitals and the Illinois Critical Access Hospital Network issued a statement saying they strongly oppose HB 3512.


by Grace Friedman
Medill Illinois News Bureau, Capitol News Illinois

SPRINGFIELD — Health care unions continue to rally for legislation to address understaffing they say strains hospitals and threatens both patient safety and staff well-being.

Lawmakers are considering the Hospital Worker Staff and Safety bill, which would establish mandatory nurse-to-patient staffing ratios and increase support for underfunded hospitals.

The proposed legislation, Senate Bill 21 and House Bill 3512, aims to establish minimum staffing ratios in hospitals and fund critical safety-net hospitals across the state. Advocates with health care worker unions have been holding a series of rallies at the Capitol in support of the legislation in recent weeks.

“Our hospitals are staffed unsafely,” Kawana Gant, a certified nursing assistant at UChicago Medicine Ingalls Memorial Hospital in Harvey, said at a recent Statehouse rally. “I have worked short shifts where there are 30 patients and only one CNA on the floor. How can you give quality care? It is not safe.”

Gant, who has worked at Ingalls Hospital for nearly 30 years, says she has watched many of her colleagues quit due to the mental and physical toll the short staffing has had on their bodies.

“This is an opportunity for legislators to hear us, to know that these hospitals are not safe.” Gant said.

But similar versions of the proposed legislation have been introduced at the Statehouse for recent years and have failed to gain traction. Generally backed by unions representing nurses, such as the Service Employees International Union, previous staffing ratio measures have run into opposition from hospital groups that say they’re unworkable.

The proposed legislation filed this year has yet to receive a hearing in a substantive committee, meaning it will be an uphill battle for it to move by the time the legislature adjourns at the end of the month.

Like previous versions, it would mandate that hospitals “employ and schedule sufficient staff to ensure quality patient care and safety.” In addition, hospitals would have to share annual staffing metrics with the Illinois Department of Public Health to help ensure they are at proper staffing levels.

“This bill gives you a real voice,” Rep. Kam Buckner, D-Chicago, said to rallygoers. “It gives you a way to speak up when things are unsafe for you and the people who you care for.”

However, not all lawmakers are convinced that now is the right time to implement staffing ratios.

“You can mandate the staffing ratios, but if those professionals don’t exist, what have you really done?” said Rep. Norine Hammond, R-Macomb. “We’ve been trying for years to get more people into the health care field, especially after COVID, and we’re just not there yet.”

Hammond expressed concern that enforcing strict staffing requirements without enough qualified workers in the pipeline could place unrealistic burdens on hospitals. She warned that such mandates might unintentionally strain facilities already struggling with labor shortages and lead to adverse financial consequences, especially for smaller or rural hospitals.

Hospital trade groups echo those concerns, calling the legislation unworkable, burdensome and an ineffective way to solve a problem that should be addressed by the specific needs of each hospital or care center. The Illinois Health and Hospital Association, the Association of Safety Net Community Hospitals and the Illinois Critical Access Hospital Network issued a statement saying they strongly oppose HB 3512.

They said it was introduced “as a backdoor effort pushed by organized labor to impose unworkable, government-imposed health care staffing ratios in Illinois.”



“This proposal would relegate the essential, complex and nuanced protocols established to safely and efficiently staff a hospital 24/7/365, to a series of burdensome forms and onerous paperwork that hospitals would be required to submit to the (IDPH) to establish minimum staffing standards for every hospital worker, in each hospital unit,” the groups said in the statement.

Still, according to a recent Service Employees International Union survey of Chicago area hospital workers, 70% of respondents reported understaffing, and over 25% reported unsafe or unmanageable workloads. Additionally, in the same survey, 47% of the respondents stated an intent to leave their jobs soon.

To help enforce safety standards, the legislation introduces “assignment despite objection forms” that give hospital workers the opportunity to document and report any assignments that they believe are unsafe. Hospitals are then required to provide this information to IDPH, which would have to publish an annual report on all these staffing metrics. The legislation would also require IDPH to “make recommendations for minimum staffing standards for hospital workers in each hospital unit.”

In addition to protecting staff, advocates said this bill would allocate proper essential resources to underfunded hospitals around the state, including Mount Sinai Hospital on Chicago's West Side, a Level 1 trauma center that helps underserved and violence-impacted communities.

“Mount Sinai saved my son's life,” said Sonya Brown, who traveled from Chicago to Springfield recently to advocate for the safety-net hospital that treated her son after he was shot seven times in 2020.

“He was shot in the head, he was shot in the neck, he was shot in the chest, the abdomen and shoulder, and the arm,” Brown said. “If they wouldn't have gotten to him in time, he would have died.”

Mount Sinai serves as a health care provider for communities on both the South and West sides of Chicago, areas that experience some of Chicago's highest rates of gun violence. If the hospitals are not protected by measures in this legislation, advocates said, the victims in these neighborhoods risk longer travel times to alternative trauma centers.

They said the bills would help allocate essential resources and enforce staffing standards at safety-net hospitals to continue effectively serving vulnerable communities.

“All of our staff is overworked,” said Jessica Mendoza, a nursing assistant at Edward Hines Jr. VA Hospital in Hines. “A lot of our veterans are coming into the VA to get help with their health, but we do not have the staff to provide it.”

Mendoza, who has worked at the Hines VA Hospital for nearly two years, said that due to the low number of staff, they rarely get a break. She noted that the lack of sufficient staffing makes it difficult to provide the level of care that the veterans need.

The health care workers and advocates gathering in Springfield at the recent rally emphasized that without sufficient staffing and resources, the quality of patient care throughout Illinois hospitals will continue declining, and worker burnout will escalate.

“They expect you to do the job of five or six people but pay you for one.” Sen. Lakesia Collins, D-Chicago, said at the rally. Prior to joining the General Assembly, Collins was a CNA in nursing homes.

As the legislation stagnates at the Capitol, hospital workers and advocates said they plan to keep organizing and sharing their stories. They said they're calling on lawmakers to prioritize frontline health care workers and the patients who depend on them.

Grace Friedman is a student in the Medill Illinois News Bureau, a program at the Medill School of Journalism that provides local news outlets with state legislature and government coverage. She can be reached at gracefriedman2025@u.northwestern.edu.

Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.

This article first appeared on Capitol News Illinois and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Biden administration sets higher staffing mandates for nursing homes

Here is the problem most nursing homes don’t meet them.
by Jordan Rau
KFF Health News

The Biden administration finalized nursing home staffing rules Monday that will require thousands of them to hire more nurses and aides — while giving them years to do so.

The new rules from the Centers for Medicare & Medicaid Services are the most substantial changes to federal oversight of the nation’s roughly 15,000 nursing homes in more than three decades. But they are less stringent than what patient advocates said was needed to provide high-quality care.

Image by Alexa from Pixabay

Spurred by disproportionate deaths from covid-19 in long-term care facilities, the rules aim to address perennially sparse staffing that can be a root cause of missed diagnoses, severe bedsores, and frequent falls.

“For residents, this will mean more staff, which means fewer ER visits potentially, more independence,” Vice President Kamala Harris said while meeting with nursing home workers in La Crosse, Wisconsin. “For families, it’s going to mean peace of mind in terms of your loved one being taken care of.”

When the regulations are fully enacted, 4 in 5 homes will need to augment their payrolls, CMS estimated. But the new standards are likely to require slight if any improvements for many of the 1.2 million residents in facilities that are already quite close to or meet the minimum levels.

“Historically, this is a big deal, and we’re glad we have now established a floor,” Blanca Castro, California’s long-term care ombudsman, said in an interview. “From here we can go upward, recognizing there will be a lot of complaints about where we are going to get more people to fill these positions.”

The rules primarily address staffing levels for three types of nursing home workers. Registered nurses, or RNs, are the most skilled and responsible for guiding overall care and setting treatment plans. Licensed practical nurses, sometimes called licensed vocational nurses, work under the direction of RNs and perform routine medical care such as taking vital signs. Certified nursing assistants are supposed to be the most plentiful and help residents with daily activities like going to the bathroom, getting dressed, and eating.

While the industry has increased wages by 27% since February 2020, homes say they are still struggling to compete against better-paying work for nurses at hospitals and at retail shops and restaurants for aides. On average, nursing home RNs earn $40 an hour, licensed practical nurses make $31 an hour, and nursing assistants are paid $19 an hour, according to the most recent data from the Bureau of Labor Statistics.

CMS estimated the rules will ultimately cost $6 billion annually, but the plan omits any more payments from Medicare or Medicaid, the public insurers that cover most residents’ stays — meaning additional wages would have to come out of owners’ pockets or existing facility budgets.

The American Health Care Association, which represents the nursing home industry, called the regulation “an unreasonable standard” that “creates an impossible task for providers” amid a persistent worker shortage nationwide.

“This unfunded mandate doesn’t magically solve the nursing crisis,” the association’s CEO, Mark Parkinson, said in a statement. Parkinson said the industry will keep pressing Congress to overturn the regulation.

Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based advocacy nonprofit, said “it is hard to call this a win for nursing home residents and families” given that the minimum levels were below what studies have found to be ideal.

The plan was welcomed by labor unions that represent nurses — and whom President Joe Biden is counting on for support in his reelection campaign. Service Employees International Union President Mary Kay Henry called it a “long-overdue sea change.” This political bond was underscored by the administration’s decision to have Harris announce the rule with SEIU members in Wisconsin, a swing state.

nurse with patient
Photo: PEXELS/Anna Shvets

The new rules supplant the vague federal mandate that has been in place since the 1980s requiring nursing homes to have “sufficient” staffing to meet residents’ needs. In practice, inspectors rarely categorized inadequate staffing as a serious infraction resulting in possible penalties, federal records show.

Starting in two years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, a KFF analysis found.

The rules give homes breathing room before they must comply with more specific requirements. Within three years, most nursing homes will need to provide daily RN care of at least 0.55 hours per resident and 2.45 hours from aides.

CMS also mandated that within two years an RN must be on duty at all times in case of a patient crisis on weekends or overnight. Currently, CMS requires at least eight consecutive hours of RN presence each day and a licensed nurse of any level on duty around the clock. An inspector general report found that nearly a thousand nursing homes didn’t meet those basic requirements.

Nursing homes in rural areas will have longer to staff up. Within three years, they must meet the overall staffing numbers and the round-the-clock RN requirement. CMS’ rule said rural homes have four years to achieve the RN and nurse aide thresholds, although there was some confusion within CMS, as its press materials said rural homes would have five years.

Under the new rules, the average nursing home, which has around 100 residents, would need to have at least two RNs working each day, and at least 10 or 11 nurse aides, the administration said. Homes could meet the overall requirements through two more workers, who could be RNs, vocational nurses, or aides.

Homes can get a hardship exemption from the minimums if they are in regions with low populations of nurses or aides and demonstrate good-faith efforts to recruit.

Democrats praised the rules, though some said the administration did not go nearly far enough. Rep. Lloyd Doggett (D-Texas), the ranking member of the House Ways and Means Health Subcommittee, said the changes were “modest improvements” but that “much more is needed to ensure sufficient care and resident safety.” A Republican senator from Nebraska, Deb Fischer, said the rule would “devastate nursing homes across the country and worsen the staffing shortages we are already facing.”

Advocates for nursing home residents have been pressing CMS for years to adopt a higher standard than what it ultimately settled on. A CMS-commissioned study in 2001 found that the quality of care improved with increases of staff up to a level of 4.1 hours per resident per day — nearly a fifth higher than what CMS will require. The consultants CMS hired in preparing its new rules did not incorporate the earlier findings in their evaluation of options.

CMS said the levels it endorsed were more financially feasible for homes, but that assertion didn’t quiet the ongoing battle about how many people are willing to work in homes at current wages and how financially strained homes owners actually are.

“If states do not increase Medicaid payments to nursing homes, facilities are going to close,” said John Bowblis, an economics professor and research fellow with the Scripps Gerontology Center at Miami University. “There aren’t enough workers and there are shortages everywhere. When you have a 3% to 4% unemployment rate, where are you going to get people to work in nursing homes?”

Researchers, however, have been skeptical that all nursing homes are as broke as the industry claims or as their books show. A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors.

Charlene Harrington, a professor emeritus at the nursing school of the University of California-San Francisco, said: “In their unchecked quest for profits, the nursing home industry has created its own problems by not paying adequate wages and benefits and setting heavy nursing workloads that cause neglect and harm to residents and create an unsatisfactory and stressful work environment.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Expected growth is creating opportunities in senior home healthcare industry

StatePoint Media - Medical professionals, patients and their families are increasingly seeing the value of home care, and the industry is expected to grow. In fact, home health and personal care aide job openings are projected to grow 33% from 2020 to 2030, with experts predicting an estimated 8.2 million job openings in home-based care by 2028. Industry experts say that workers from all backgrounds, not just nursing, will be needed now and in the future.

"If you enjoy working with people and helping others when they need it most, a job as a home care or hospice nurse, home health aide, personal companion or caregiver could be a good fit for you," says Jennifer Sheets, president and chief executive officer of industry leader, Interim HealthCare Inc. "Likewise, if you're currently a medical professional seeking more flexibility and to be reminded of why you entered the field in the first place, home healthcare can offer greater job satisfaction and a much-needed change of pace."

To help potential job candidates understand this growing industry, Interim HealthCare is sharing some quick insights:

Why In-Home Care?

Home care describes personal care and support services provided to an individual in their home. Often referred to as senior care, it provides help with the activities of daily living as well as companionship to those who need support to maintain their independence at home. Home healthcare on the other hand, entails medical-based care to help patients recover from an illness or injury, or to provide in-home medical oversight and ongoing care for complex, chronic medical conditions. Many families and patients can testify to the various ways home care can be a game-changer, and a growing number of physicians and medical professionals are recommending home health services to patients of all ages because it delivers cost-effective, high-quality care in the setting where patients most often want to be -- home. Among these services are in-home nursing, physical, occupational and speech therapy, hospice care and bereavement services.

What Employers Want

Those in the know at Interim HealthCare say that being compassionate, trustworthy, dependable and having the ability to work independently can help you thrive in the field of home care. "Made for This," Interim's current recruitment campaign, highlights the company's need for registered nurses, licensed practical and vocational nurses, along with certified nursing assistants, home care aides, home physical therapists, occupational therapists and speech therapists. Veterans, with their track record of serving and protecting others, are encouraged to apply for a home care job, along with anybody who thrives in a job that offers variety, challenge and new faces and places.

What to Look for in Employers

Seeking a career in the field of home care? Be sure you work for a home healthcare organization with a positive work culture that has your best interests in mind. That includes offering good work-life balance, flexible schedules, rewarding assignments and competitive pay. The employer should also prioritize your continuing education and professional development by offering advanced learning opportunities and room for growth, along with additional perks like tuition discounts, to make it all possible.

For a home healthcare career guidebook, visit info.interimhealthcare.com/jobs-in-home-healthcare.

As demand for medical and personal care in the home grows, consider a career in this thriving field, whether you're entering the workforce for the first time or embarking on a career change.

Medical crisis on the horizon, more than a quarter of practicing nurses want to leave the medical industry

Photo: Hamid Tajik/Unsplash

StatePoint Media -- According to a new survey, American nurses are overwhelmed by job demands, a long-brewing situation only exacerbated by the COVID-19 pandemic. While the majority of nurses continue to be dedicated to the care of patients, many are considering leaving the profession at a time when staff shortages are part of the problem. But there’s hope, according to industry experts, who say that understanding these challenges can lead to meaningful and necessary reforms.

The 2022 national survey, “The Future of Nursing: A Profession in Crisis,” of nurses and student nurses, was conducted by Cross Country, a market-leading tech-enabled workforce solutions platform and advisory firm, in partnership with Florida Atlantic University’s Christine E. Lynn College of Nursing.

Overall, the study revealed that nurses remain passionate about patient care, with 66% citing helping people through meaningful work as a main driver for staying in the field. Nevertheless, ongoing challenges have created undue burdens for nurses, with pay rates/compensation (86%), staff shortages (53%), stress (39%) and burnout (35%) cited as top career dissatisfiers.

This frustration has put the industry in crisis: 28% of nurses indicated their desire to leave the profession has increased dramatically since the pandemic, while those who said their desire to stay has dropped from 24% in 2021 to 4% in 2022. This translates to a real potential loss of talent in hospitals, physicians’ offices, long-term care facilities and other healthcare settings. Of those surveyed, 23% plan to look for a new career in 1-2 years and 13% plan to retire in 1-5 years.

“We had hoped that as the pandemic eased, nurses would have better balance, mental health and working conditions, but we are not there and as a result, nurses are leaving the profession in droves,” says John A. Martins, president and chief executive officer, Cross Country Healthcare. “The time to fix these mounting problems is now.”

To that end, Cross Country is deploying several strategies to transform the nursing profession. These include an ongoing examination of pay rates and retention practices; identifying new pathways for education, licensing, and talent development; focusing on flexibility and growth opportunities; and investments toward innovation to strengthen the nursing workforce.

The company continues to invest heavily in technology and digital transformation to support these strategies. Among these initiatives is a new website dedicated to nursing candidates. Found at crosscountry.com, the site aims to help health care professionals find and engage with potential job opportunities more effectively.

Identifying new pathways for nursing education is also a critical steppingstone towards reforming the profession and addressing healthcare provider shortages. That’s why the Christine E. Lynn College of Nursing offers accredited programs at all levels to prepare and train students, including various tracks for a BSN, Master of Science in Nursing (MSN), PhD and DNP focused on Caring Science. Also offered are a BSN-DNP program with a Psychiatric Mental Health Nurse Practitioner concentration and post-graduate dermatology and telehealth certificate courses, as well as other concentrations that intersect innovation and technology.

“Nursing is the greatest profession in the world. The experience you will get is priceless,” said one of the survey respondents. “Make sure you’re getting into nursing for the right reasons because I love coming to work and look forward to caring for patients every day. No two patients are alike, so every day in nursing is like a new experience and adventure. And you make the difference.”

To learn more about the challenges facing the nursing industry, visit crosscountry.com/the-future-of-nursing, where the complete study results, can be found.


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