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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| SENATE BILL |
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| INTRODUCED BY WASHINGTON, FERLO, TARTAGLIONE, FONTANA AND KITCHEN, JANUARY 20, 2009 |
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| REFERRED TO PUBLIC HEALTH AND WELFARE, JANUARY 20, 2009 |
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| AN ACT |
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1 | Requiring long-term care nursing facilities to maintain certain |
2 | staffing levels in order to protect the health and safety of |
3 | residents and employees; providing for powers and duties of |
4 | the Department of Health; and imposing civil penalties. |
5 | The General Assembly finds and declares as follows: |
6 | (1) The Commonwealth has a large and growing population |
7 | of senior and disabled persons who require nursing facility |
8 | care. |
9 | (2) Significant staffing resources are necessary to |
10 | provide quality care to our senior and disabled citizens who |
11 | reside in nursing homes. |
12 | (3) Long-term care nursing facilities which receive |
13 | public money should be required to provide at all times |
14 | staffing resources to meet the minimum levels necessary to |
15 | provide quality care to each resident. |
16 | (4) Nursing facilities which receive public money have a |
17 | responsibility to report to residents, their families and the |
18 | taxpayers of this Commonwealth the staffing levels that they |
19 | provide for the residents in their care. |
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1 | The General Assembly of the Commonwealth of Pennsylvania |
2 | hereby enacts as follows: |
3 | Section 1. Short title. |
4 | This act shall be known and may be cited as the Nursing Home |
5 | Staffing Level Act. |
6 | Section 2. Definitions. |
7 | The following words and phrases when used in this act shall |
8 | have the meanings given to them in this section unless the |
9 | context clearly indicates otherwise: |
10 | "Acuity system." An established measurement instrument |
11 | which: |
12 | (1) Predicts direct care requirements for each |
13 | individual resident based on severity of resident illness, |
14 | need for specialized equipment and technology, intensity of |
15 | nursing interventions required and the complexity of clinical |
16 | nursing judgment needed to design, implement and evaluate a |
17 | resident's care plan. |
18 | (2) Details the amount of direct care needed, both in |
19 | number of direct care nurses and skill mix of care personnel |
20 | required, on a daily basis, for each resident in a facility. |
21 | (3) Is stated in terms that readily can be used and |
22 | understood by direct care staff. |
23 | (4) Takes into consideration the resident care services |
24 | provided not only by registered nurses but also by licensed |
25 | practical nurses, nurse aides and other care personnel. |
26 | "Afternoon shift." A shift commencing no earlier than 2 p.m. |
27 | and no later than 4 p.m. |
28 | "Assessment tool." A measurement system which compares the |
29 | staffing level in a facility against actual resident care |
30 | requirements in order to review the accuracy of an acuity |
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1 | system. |
2 | "Department." The Department of Health of the Commonwealth. |
3 | "Facility." A long-term care nursing facility. |
4 | "Licensed nurse." A registered nurse or licensed practical |
5 | nurse. |
6 | "Morning shift." A shift commencing no earlier than 6 a.m. |
7 | and no later than 8 a.m. |
8 | "Nighttime shift." A shift commencing no earlier than 10 |
9 | p.m. and no later than 12 midnight. |
10 | "Nurse aide." An individual who provides nursing or nursing- |
11 | related services to residents in a facility. The term does not |
12 | include an individual who is a licensed health professional or |
13 | volunteers to provide such services without monetary |
14 | compensation. |
15 | "Shift." A work period consisting of approximately eight |
16 | hours unless otherwise established under a collective bargaining |
17 | agreement. |
18 | Section 3. Minimum staffing standards for nurse aides and |
19 | licensed nursing personnel. |
20 | (a) General rule.--Beginning two years after the effective |
21 | date of this section, the department shall not issue or renew a |
22 | license of a facility unless that facility employs nursing |
23 | personnel sufficient in number as set forth in this section to |
24 | provide continuous 24-hour nursing care and service necessary to |
25 | meet the needs of each resident in the facility. |
26 | (b) Minimum allocations.-- |
27 | (1) The ratios set forth in subsections (c) and (d) |
28 | shall constitute the minimum number of nurse aides and |
29 | licensed nurses to be allocated on each shift. Additional |
30 | nurse aides and licensed nurses shall be added and the ratio |
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1 | adjusted to ensure adequate staffing of each shift and each |
2 | care unit in accordance with an approved acuity system. |
3 | (2) Nothing in this section shall be construed to |
4 | preclude the department from establishing and requiring a |
5 | staffing plan to have higher staff-to-resident ratios than |
6 | those set forth in subsections (c) and (d). |
7 | (c) Nurse aide ratios.--A facility shall maintain a ratio of |
8 | residents to nurse aides of no more than: |
9 | (1) Eight to one during a morning shift. |
10 | (2) Ten to one during an afternoon shift. |
11 | (3) Fifteen to one during a nighttime shift. |
12 | (d) Licensed nurse ratios.--A facility shall maintain a |
13 | ratio of residents to licensed nurses, either registered nurses |
14 | or licensed practical nurses, of no more than: |
15 | (1) Fifteen to one during a morning shift. |
16 | (2) Twenty-five to one during an afternoon shift. |
17 | (3) Thirty-five to one during a nighttime shift. |
18 | (e) Restrictions on nursing staff services.--No employee |
19 | designated as a member of the nursing staff shall provide the |
20 | following services: |
21 | (1) Food preparation. |
22 | (2) Housekeeping. |
23 | (3) Laundry. |
24 | (4) Maintenance. |
25 | (f) Restrictions on other services.--A person employed to |
26 | provide the services under subsection (e) shall not provide |
27 | nursing care to residents and shall not be counted in |
28 | determining the ratios in subsections (c) and (d). |
29 | Section 4. Facility implementation of acuity system. |
30 | A facility shall implement an acuity system within two years |
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1 | of the effective date of this section in accordance with this |
2 | act and regulations promulgated under this act. |
3 | Section 5. Public right to staffing information. |
4 | (a) General rule.--A facility shall post for each care unit |
5 | of the facility and for each shift the current number of |
6 | licensed nurses and nurse aides directly responsible for |
7 | resident care and any other staff directly responsible for |
8 | resident care and the current ratios of residents to staff, |
9 | which show separately the number of residents to licensed nurses |
10 | and the number of residents to nurse aides. |
11 | (b) Posting requirements.--The information shall be posted: |
12 | (1) For the most recently concluded cost reporting |
13 | period in the form of average daily staffing ratios for that |
14 | period. |
15 | (2) In a manner and form which is visible, easy to read |
16 | and to understand, and accessible to all residents, their |
17 | families, caregivers and potential consumers in the facility. |
18 | Section 6. Enforcement. |
19 | (a) Civil penalty for staffing violation.--The department |
20 | shall impose a civil penalty upon any facility that fails to |
21 | meet the staffing requirements set forth in section 3. The |
22 | penalty shall be imposed for each day on which the failure |
23 | occurs. |
24 | (b) Amount of penalty.--The amount of penalty in subsection |
25 | (a) shall be determined as follows: |
26 | (1) For deficiencies in staffing which constitute |
27 | immediate jeopardy as determined by the department to |
28 | resident health or safety and for repeat deficiencies when a |
29 | monetary penalty has been previously imposed, the amount of |
30 | the penalty shall be not less than $3,000 nor more than |
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1 | $10,000 for each day of such failure. |
2 | (2) For deficiencies in staffing which do not constitute |
3 | immediate jeopardy to resident health or safety, the amount |
4 | of the penalty shall be not less than $50 nor more than |
5 | $3,000 for each day of such failure. |
6 | (c) Civil penalty for posting violation.--The department |
7 | shall impose a civil penalty upon any facility that fails to |
8 | meet the posting requirements set forth in section 5. The |
9 | penalty shall be in the amount of $100 for each day upon which |
10 | the facility fails to fully satisfy the posting requirements of |
11 | this act. |
12 | (d) Legal presumption.--In addition to the penalty set forth |
13 | in subsections (a) and (b), in any action brought by or on |
14 | behalf of a resident of a facility, the resident's heirs, or |
15 | both, for negligent infliction of harm or lack of adequate care, |
16 | a failure to meet the staffing requirements of section 3 shall |
17 | be presumed a contributory cause of any injury sustained by a |
18 | resident. |
19 | Section 7. Regulations. |
20 | The department shall promulgate rules and regulations |
21 | necessary to carry out this act, which shall include the |
22 | following: |
23 | (1) Licensed nurse and nurse aide staff-to-resident |
24 | ratios. |
25 | (2) Acuity system parameters to be met by a facility, |
26 | including, but not limited to, the following: |
27 | (i) The assessment of resident acuity through the |
28 | minimum data set and other factors the department may |
29 | deem appropriate. |
30 | (ii) The classification of facility residents by |
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1 | specific categories based on the resource utilization |
2 | group system and other factors the department may deem |
3 | appropriate. In establishing the specific categories, the |
4 | department shall consider a separate assessment and |
5 | categorization methodology for special populations |
6 | including, but not limited to, residents with behavioral |
7 | health problems, Alzheimer's disease and developmental |
8 | disabilities. |
9 | (3) The process for approval and monitoring compliance |
10 | of acuity systems. The regulations may include a system for |
11 | class approval of acuity systems. |
12 | (4) An accessible and confidential system to report the |
13 | failure to comply with requirements of this act and public |
14 | access to information regarding reports of inspections, |
15 | results, deficiencies and corrections under this act. |
16 | (5) Enforcement procedures. |
17 | Section 8. Effective date. |
18 | This act shall take effect in 60 days. |
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