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                                                       PRINTER'S NO. 731



No. 649 Session of 2007

           C. WILLIAMS AND BOSCOLA, MARCH 23, 2007


                                     AN ACT

     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

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

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