Rhode Island nursing home bill veto response – Herb Weiss

By Herb Weiss, contributing writer on aging issues

With the adjourning of the General Assembly on the early morning of June 14, out of thousands of bills thrown into the legislative hopper in this year’s legislative session, 249 bills passed both chambers.  At press time, Gov. Dan McKee has vetoed five bills, including one to create a Rhode Island Nursing Home Workforce Standards Advisory Board (WSB).

Just weeks after the General Assembly overwhelmingly approved the establishment of a 13-member advisory board to keep state leaders informed on current market conditions, wages, benefits and working conditions in Rhode Island’s nursing home industry, McKee vetoed the legislation. The final vote count for H 7733 A was 63-7 in the House and 37-0 in the Senate for S 2621 A.

WSB would advise the General Assembly and the RI Department of Labor and Training on market conditions, wages, benefits and working conditions in the nursing home industry; recommend minimum statewide compensation and working standards for nursing home workers; propose minimum standards for nursing home training programs and assist in ensuring compliance by employers with the recommended standards.

This advisory board would consist of three members representing nursing home employers, three representing nursing home workers, two representing community organizations that work with the Medicaid population, one member representing a joint labor-management multi-employer nonprofit training fund, and representatives of the Health and Human Services secretary, the Department of Labor and Training, the Department of Health and the Long-Term Care State Ombudsman.

Reasons Gov. wielded his veto pen

On June 26, Gov. McKee’s 2-page veto message to House Speaker K. Joseph Shekarchi (D-Dist. 13, Warwick) and Senate President Dominick Ruggerio (D- Dist. 4, Providence, North Providence) outlined his objections to creating the WSB.   

“Rhode Island needs comprehensive solutions to resolve its critical nursing home emergency and support residents, workers and the long-term care facilities,” stated McKee, stressing that the Act didn’t meet that need.

McKee noted that letters submitted by nursing homes and assisted living facilities opposing this legislation charged that the Act didn’t address real issues faced by facilities, including “years of underfunding, increased costs and the lack of available workforce in the state.”

The Board created by the Act focused narrowly on only working conditions and wages without consideration for the key constraints such as reimbursement, the governor told lawmakers.  This will not “generate the comprehensive solutions Rhode Island needs to address the nursing home emergency,” he added.

Aging advocacy groups call for an override of the veto

“Governor McKee’s veto of legislation to create the WSB is a significant setback in our efforts to improve the quality of care in Rhode Island’s nursing homes and to find a way out of the nursing home crisis,” charges Kathleen Gerard, Director of Advocates for Better Care in Rhode Island (ABC-RI) in a statement quickly released after the governor’s veto.

“The veto yet again underscores the reality that the McKee administration has created no framework or plan to stabilize our state’s broken nursing home system,” says Gerard. “Instead of once again catering to the concerns of for-profit facility owners, Governor McKee must prioritize the needs of thousands of nursing home residents and caregivers who continue to suffer from the staffing crisis,” she adds.

According to Gerard, Governor McKee says that the WSB is not a sufficiently comprehensive solution, but the governor himself has proposed no alternative solutions. “In fact, when convening his own closed-door nursing home advisory board, he initially included only industry representatives, then perfunctorily invited union representatives for the final meeting, but failed to include consumer advocates, Long Term Care Ombudsmen, or Medicaid experts,” charged Gerard.  

Gerard notes that the only recommendation from the industry members in this group was to indefinitely suspend enforcement of the Nursing Home Staffing and Quality Care Act—a course of inaction which lacked any basis in evidence and did nothing to ameliorate any of the critical problems with care in Rhode Island nursing homes. “In fact, that course only hurt the facilities that were consistently meeting minimum staffing requirements,” she says.

“Governor McKee’s veto of the WSB is a devastating blow to the residents of Rhode Island’s nursing homes,” says Raise the Bar on Resident Care Coalition in a released statement. Currently, 34 out of 74 nursing homes are rated by the Centers for Medicare & Medicaid Services at two CMS stars or lower, indicating a dire need for improvement in care standards, notes the resident advocacy coalition. 

According to WSB, the legislation creating the Nursing Home Workforce Standards Board would have ensured better training and working conditions for caregivers, which are essential for enhancing the quality of resident care. Rhode Island ranked second in the nation for serious nursing home deficiencies in the last three years, highlighting the urgent need for comprehensive solutions that prioritize the health and safety of residents.

Raise the Bar urges the Rhode Island General Assembly to override McKee’s veto. “The WSB bill was a necessary step towards ensuring better wages, benefits, and training for caregivers, and higher quality care for residents,” says the advocacy coalition, calling on the McKee administration “to remember its promises and create a comprehensive plan to end the nursing home crisis in Rhode Island.”

“The Senior Agenda Coalition of RI (SACRI) is extremely disappointed with Governor Dan McKee’s veto of the legislation passed by the House and Senate to create a Nursing Home Workforce Standards Advisory Board, andn we are calling for the general assembly to override the veto”, said Diane Santos, SACRI’s Chair, in a statement.

There are significant issues impacting the state’s nursing homes from how they are financed; the adequacy of staffing levels, training and wages; and the quality monitoring process, stated Santos. “As the state’s population grows older there will be an ongoing need to provide quality nursing home care for those with high support needs. It is critical that the many issues facing the nursing home industry be addressed,” she said.

ABC-RI and Raise the Bar strongly urge the Rhode Island General Assembly to override McKee’s veto and allow the creation of the WSB. 

In response to the aging advocacy groups calling for a veto override, House Speaker Shekarchi and Senate President Ruggerio issued statements pledging to review the Governor’s veto messages and to confer with each other and lawmakers to determine their response.  

Provider groups give thumbs-up to Gov. McKee’s veto

The state’s largest nursing home provider group agrees with Gov. McKee’s veto of the Workforce Standards Advisory Board, says John E. Gage, President and CEO of the Rhode Island Health Care Association. “This legislation would have set a precedent, establishing an Advisory Board with a narrow and ill-defined mission that failed to recognize the myriad of challenges facing nursing homes in Rhode Island and across the nation,” says Gage,  “these challenges include chronic Medicaid underfunding, skyrocketing costs, a historic workforce shortage, and the existing staffing mandate that is unfunded and fails to address the workforce crisis and includes draconian fines and penalties.”

According to Gage, S 2621A and H 7733A would also have replicated the many layers of existing oversight authority that exists at both state and federal levels – including CMS, the Occupational Safety & Health Administration, the RI Executive Office of Health & Human Services, the RI Department of Health, and the RI Department of Labor & Training, among others.

“There needs to be a comprehensive solution to the current environment of care facing Rhode Island’s nursing homes,” says Gage, stressing that this strategy should include workforce training programs, student loan forgiveness for RI nursing home professionals including RNs, LPNs and CNAs who are trained and choose to remain in RI to work in long-term care settings.

“In addition, reimbursement from Medicaid must become and remain adequate to cover the increasing cost of care in all settings, and changes are needed to address the staffing mandate passed back in 2021,” says Gage, noting that the bill was passed in the midst of the Covid-19 pandemic without addressing the workforce crisis and failing to provide sufficient funding that would be needed to layer in sufficient staff to meet the metrics, if those staff could be found.

Gage says that if fully implemented and enforced, fines would amount to $100 million in the first full year of enforcement – closing the majority of facilities, displacing thousands of vulnerable residents from their homes and devastating access to care for Rhode Island seniors.

LeadingAge RI agrees with RIHCA’s detailed observations about this issue and the Governor’s veto message, which highlight the myriad of entities already in place to oversee and enforce nursing home care, says James Nyberg, Executive Director of LeadingAgeRI. “Furthermore, the Governor noted the need for a more comprehensive solution to the nursing home emergency, and steps are already being taken or are in place towards this goal,” he said.

According to Nyberg, the Governor and General Assembly just made a significant investment in the chronically underfunded industry in this year’s budget, which will benefit all residents and staff.  In addition, the industry has regular meetings with the Health Department and Centers for Medicare & Medicaid Services to  discuss any quality-of-care issues and how to mitigate and resolve them immediately, he says, noting that these meetings are frank and productive. 

Nyberg noted that the industry, and individual nursing homes, also provide countless hours of educational programming to support and improve quality of care.  “All nursing home providers are working to overcome the challenges facing the industry, and demonizing them is disrespectful to the thousands of individuals who work 24/7/365 to care for our older Rhode Islanders,” he says.

As the dust settles…

Last Monday, Gov. McKee’s veto message was sent to House Speaker Shekarchi and Senate President Ruggerio to notify them of his veto. Now they can either let the veto stand or allow it to die.  Overriding the veto can occur if three-fifths of members in both chambers vote to affirm the bill’s passage. This vote would need to take place before the start of the new law-making session in January.

As the dust settles after McKee’s vetoing of legislation to create a WSB, with the overwhelming support of the General Assembly and the lobbying of resident advocacy groups opposing McKee’s veto, will the General Assembly have the political will to act and override the governor’s veto, especially during a time when lawmakers are just beginning their political campaigns? 

We’ll see…

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To read more articles by Herb Weiss, go to: https://rinewstoday.com/herb-weiss/

Herb Weiss, LRI -12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 43 years. To purchase his books, Taking Charge: Collected Stories on Aging Boldly and a sequel, compiling weekly published articles, go to herbweiss.com.