Some New York nursing homes are likely to scale back their use of higher-trained personnel if proposed minimum staffing ratios become law, according to a review of existing employment patterns.

Many facilities currently employ more licensed nurses than would be required by the bill, but fall short of the proposed minimums for certified nursing aides and total staffing.

In order to fully comply on tight budgets, some of those facilities would be likely to replace some of their licensed nurses with less trained and less expensive nursing aides.

Many of the state’s certified nursing aides, or CNAs, are represented by the labor union 1199SEIU, which played a key role in negotiating the nursing-home staffing bill.

Licensed nurses are mostly represented by the New York State Nurses Association, which pushed for companion legislation focused on hospitals. That proposal would require each hospital to develop its own staffing standards through labor-management committees.

The committee-based approach has gotten a mixed reception from hospital groups – with some in support and others opposed. The nursing-home staffing bill faces broad opposition from industry officials.

They say their facilities are already struggling with shortages of available employees and cannot afford the higher payroll costs, which they estimate at $260 million a year.

The potential pressure to employ fewer licensed nurses is a byproduct of the proposal’s three staffing minimums. On average for each resident, facilities would be required to provide at least 3.5 hours of caregiver time per day, including at least 1.1 hours of attention from licensed nurses and 2.2 hours from CNAs.

According to data compiled by the industry group Leading Age New York, the median level of licensed nurse staffing in 2020 exceeded the proposed minimum, but the median levels for CNAs and total staffing fell short of what the law would require.

As seen in the table below, just 26 percent of homes were below the proposed standard for licensed staff, compared to 54 percent for CNAs and 55 percent for overall staffing.

Just over 200 homes, or about one third of the total, met all three of the proposed minimums in 2020, according to the data.

Roughly another third of homes met or exceeded the licensed staffing minimum but fell short on one or both of the other standards. If the legislation is passed in its current form, those facilities would be obliged to hire more non-licensed staff, and would face financial pressure to shed licensed staff in the process.

The staffing shortfalls would be more pronounced among for-profit facilities and among homes located in the downstate region, the Leading Age data indicate.

The minimum staffing bills for nursing homes and hospitals are sponsored by Assemblywoman Aileen Gunther of Sullivan County and Senate Health Chairman Gustavo Rivera of the Bronx. The current versions were introduced on April 22, moved quickly through the committee process and could receive a final vote in each house as soon as next week.


About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

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