Bill Text: PA SB182 | 2011-2012 | Regular Session | Introduced

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Bill Title: 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.

Sponsorship: Partisan Bill (Democrat 4)

Status: (Introduced - Dead) 2011-03-22 - Referred to PUBLIC HEALTH AND WELFARE [SB182 Detail]

Download: Pennsylvania-2011-SB182-Introduced.html

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PRINTER'S NO. 876
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 182 Session of2011
INTRODUCED BY WASHINGTON, FERLO, KITCHEN AND STACK, MARCH 22, 2011
REFERRED TO PUBLIC HEALTH AND WELFARE, MARCH 22, 2011
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.
"Department." The Department of Health of the Commonwealth.
"Facility." A long-term care nursing facility.
"Licensed nurse." A registered nurse or licensed practical
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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
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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
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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
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$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
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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.
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