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Quality of care

New requirements will improve the quality of care at all Oregon nursing homes, state officials say.

Calling it a "major step forward in improving the standard of care for one of Oregon's most vulnerable populations," Department of Human Services Director Dr. Bruce Goldberg announced new staffing standards Tuesday for all of Oregon's nursing homes.

The new rules that went into effect Saturday mean nursing homes will need to employ more nursing assistants and residents should therefore receive more help with daily activities. The new standards require day shift assistants to have two fewer people under their care, allowing them to spend more time with each resident. The new rules also mean that Oregon will need about 500 to 700 additional nursing assistants by 2010.

There are 142 licensed care centers in Oregon. Jackson County has five with a maximum capacity of 596 patients.

Nursing assistants aid in the daily, basic care of residents, providing everything from assistance in eating and dressing to helping move from one part of the building to another.

Linda Vista Nursing and Rehab Center in Ashland has been running at the new standard for the past month, said Susan Abblitt, registered nurse and utilization review coordinator.

"I think it's wonderful," Abblitt said. "It's good for us and it's good for the patients. It's about time."

Oregon's minimum staffing requirements for assistants has not been increased since 1993, which led to concerns that basic care in nursing homes was suffering. In 2006, Gov. Ted Kulongoski convened a commission to review the issue and make recommendations on how best to proceed to increase staffing levels at state nursing homes.

"Any increase in the staffing is very good news. Some facilities may need to increase staffing immediately. Others have already increased staff," said Meredith Cote, director of the Office of the Long Term Care Ombudsman in Salem.

The state ombudsmen agency provides advocacy for residents of nursing homes, adult foster care homes, residential care and assisted living centers, Cote said. The new requirements are being phased in over three years. The staff-to-resident ratio will narrow again as Phase 2 on April 1, 2009. A third phase would require approval from the 2009 Legislature.

The biggest challenge for some will come in 2009, said Scott Nay, administrator for Three Fountains nursing home in Medford.

"We're not doing badly," Nay said. "We did have to add two new positions to meet the current requirements. But, in 2009, that's where it's going to require four or five new positions."

Nursing assistants who testified before the commission emphasized the importance of maintaining dignity and respect for nursing home residents. As one reminded the commissioners, residents could be "your mother, your grandmother."

New standards for transparency and accountability also have been established to ensure that nursing homes are meeting the new staffing requirements. They must post their daily staffing ratios in public view and report the staffing ratios to the Department of Human Services every quarter.

For the first time, DHS is going to monitor the staffing in nursing homes quarterly, said Cote.

"Before these new standards, if we thought an agency wasn't meeting sufficient staffing, DHS would not investigate or pursue that complaint unless we could cite significant negative outcomes for the residents. Now they want to hear," Cote said.

Cote's agency has asked DHS to post current staffing for each nursing home in the state "so one could see how much each facility would have to increase staffing to meet the new standards," Cote said.

"We thought that would be helpful. But we have heard that data is not yet available," she said.

The improved staffing-to-resident ratios will be phased in over three years to allow homes time to train and hire certified nursing assistants. The industry is most concerned about the requirement for hundreds of new certified nursing assistants, Cote said.

"The concerns are if there are enough CNAs to go around," she said.

Abblitt says her employer offers CNA training programs.

"The CNA classes run every eight weeks, five days a week, eight hours a day," she said.

Another concern is increased costs. Most nursing homes depend heavily on public programs (Medicaid) for funding. To help them cover the costs of the new staffing, the state will subsidize the care at a rate of $2.86 per Medicaid resident per day, Cote said.

Reports of low staffing levels or other questions or concerns about the new rules should be directed to the Department of Human Services Client Care Monitoring Unit at 877-280-4555. For a full description of the staffing ratios, go to www.oregon.gov/DHS/index.shtml online.

Reach reporter Sanne Specht at 776-4497 or e-mail sspecht@mailtribune.com.

Certified nursing assistants Stephanie Smith, left, and Sarah Tobiasson help Paul Arapoff at Linda Vista Care Center in Ashland on Wednesday. Mail Tribune Photo / Jamie Lusch - Jamie Lusch