养老院行业希望特朗普撤销人员配备规定

【中美创新时报2024 年 11 月30 日编译讯】（记者温友平编译）几个月来，养老院行业一直在国会共和党人——甚至一些民主党人——中煽动反对，以推翻拜登政府的授权。《纽约时报》记者乔丹·劳对此作了下述报道。

COVID-19 在美国养老院肆虐，导致超过 172,000 名居民死亡，并引发了几十年来最大的行业改革：规定养老院必须雇用最低数量的护士。

但随着当选总统唐纳德·特朗普重返白宫，该行业正在加大压力，要求在该要求生效前取消该要求，导致养老院的数千名居民人手不足，无法提供适当的护理。

几个月来，养老院行业一直在国会共和党人——甚至一些民主党人——中煽动反对，以推翻拜登政府的授权。两个行业组织，美国医疗保健协会和 LeadingAge，已提起诉讼，要求推翻该法规，20 名共和党州检察长也提起了自己的诉讼。

消费者权益倡导者、行业官员和独立研究人员一致认为，鉴于第一届特朗普政府发起的“患者优先于文书工作”运动，新政府很可能会撤销该规则，旨在取消“对医院和其他医疗保健提供者的不必要、过时或过于繁重的卫生法规”。除其他外，特朗普还通过减轻对护理不佳的养老院的罚款来帮助该行业。

“特朗普政府已经证明自己非常渴望扭转过度监管，”代表非营利性老年护理提供者的 LeadingAge 政策和宣传高级副总裁 Linda Couch 表示。“我们认为它很有可能被废除，希望如此。”

人员配备规定于 4 月发布，要求养老院全天候配备注册护士（这是业界认可的），并保持最低数量的护士和助手。五分之四的养老院必须增加人员配备。这些要求将从 2026 年 5 月开始分阶段实施。

即使在选举之前，许多专家和活动人士也怀疑这项规定能否得到有效执行，因为在实施最低标准的州，结果不佳。在纽约州、加利福尼亚州、罗德岛州和马萨诸塞州（要求最严格的州），许多养老院的人员配备水平仍低于法定水平。州长们给许多养老院放了缓刑，其他养老院发现支付罚款的成本低于增加员工工资的成本。

联邦政府估计，十年内满足拜登的要求，每年平均成本为 43 亿美元，支出增加 2%，但这些变化不包括联邦医疗保险或医疗补助支付的增加。

“就养老院质量而言，人员配备至关重要，”芝加哥大学公共卫生科学教授 R. Tamara Konetzka 表示。

虽然该规则的有效性尚不确定，但她担心废除它会发出错误的信息。“我们将失去养老院应该努力改善人员配备的信号，”她说。

养老院居民的倡导团体曾批评拜登政府的规定没有要求更高的人员配备水平，但此后他们转变了立场，试图保护这条规定。

“我们希望当选总统能上任，看看背后的科学和数据，看看这真的是一项温和的改革，”华盛顿非营利组织全国优质长期护理消费者之声公共政策主任 Sam Brooks 说。“如果这条规定被废除，我们会很伤心。”

特朗普过渡团队没有回应置评请求。卫生与公众服务部没有回应置评请求，但在一份法庭文件中，它辩称养老院应该能够达到所需的人员配备水平。

“有足够的时间来识别、培训和雇用额外的员工，”拜登政府写道。

几十年来，全国 15,000 家养老院的护理质量以及 120 万居民缺乏足够的工作人员一直令人担忧。检查报告继续发现，养老院让居民躺在自己的粪便中，遭受严重的褥疮和摔倒，感染，无人看管时被食物噎住，或因可预防的原因而最终回到医院。一些养老院过度使用精神药物来安抚居民，因为他们没有足够的工作人员来照顾他们。

代表医护人员的服务雇员国际工会 (SEIU) 执行副总裁 Leslie Frane 在一份声明中表示，“太多养老院业主不会做正确的事情，不会在没有监督和约束性监管的情况下投资员工。”

养老院行业表示，许多养老院无法承担增加员工数量的费用，即使可以，也缺乏训练有素的护士，也没有足够的人愿意以平均每小时 19 美元的工资担任助理。根据劳工统计局的数据，一名注册护士在养老院的平均时薪为 40 美元，低于他们在医院的工资。

拜登政府在其法庭文件中指出，计划花费 7500 万美元招募和培训更多员工，有超过 10 万名员工在疫情期间离开了养老院，如果工资和工作条件更好，他们可能会被吸引回来。

由于政府对财务透明度的要求存在薄弱环节，有多少养老院能够负担得起增加的成本仍然是个谜。根据他们向医疗保险局提交的报告，大约有一半的养老院处于亏损状态，但一些养老院业主通过秘密手段将利润中饱私囊而致富。

本月，纽约州最大的养老院连锁机构之一 Centers Health Care 的业主同意支付 4500 万美元，以和解总检察长莱蒂塔·詹姆斯 (Letita James) 的指控，即他们在疫情期间将原本用于住院护理的 8300 万美元挪作己用。

Centers Health Care 连锁机构的发言人 Maryellen Mooney 否认了这些指控，她在一份声明中表示，Centers“致力于全面执行和解条款，包括对住院护理进行大量投资”。

政府估计，如果与全国平均水平相比，其所在社区的护士和助手短缺，全国约四分之一的养老院将有资格申请困难豁免。

但好撒玛利亚人协会 (Good Samaritan Society) 首席执行官内特·施梅克 (Nate Schema) 估计，只有七家机构可能符合困难豁免条件。该协会主要在美国中西部农村地区经营 133 家非营利性机构。

“从理念上讲，这些机构听起来很棒，”他说，“但从实际操作和具体实施情况来看，它们对我们帮助不大。”

本文最初发表于《纽约时报》。

题图：2020 年，华盛顿州柯克兰生命护理中心的一名居民透过窗户被看到。格兰特·辛德斯利/纽约时报

附原英文报道：

Nursing home industry wants Trump to rescind staffing mandate

By Jordan Rau New York Times,Updated November 29, 2024 

A resident was seen through a window at the Life Care Center of Kirkland, Wash. in 2020.Grant Hindsley/NYT

COVID-19’s rampage through the country’s nursing homes killed more than 172,000 residents and spurred the biggest industry reform in decades: a mandate that homes employ a minimum number of nurses.

But with President-elect Donald Trump’s return to the White House, the industry is ramping up pressure to kill that requirement before it takes effect, leaving thousands of residents in homes too short-staffed to provide proper care.

The nursing home industry has been marshaling opposition for months among congressional Republicans — and even some Democrats — to overrule the Biden administration’s mandate. Two industry groups, the American Health Care Association and LeadingAge, have sued to overturn the regulation, and 20 Republican state attorneys general have filed their own challenge.

Consumer advocates, industry officials, and independent researchers agree that the incoming administration is likely to rescind the rule, given the first Trump administration’s “patients over paperwork” campaign to remove “unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other health care providers.” Among other things, Trump aided the industry by easing fines against homes that had been cited for poor care.

“The Trump administration has proven itself really eager to reverse overreaching regulations,” said Linda Couch, the senior vice president for policy and advocacy at LeadingAge, which represents nonprofit elder care providers. “We think it’s got a pretty good chance of being repealed, and hope so.”

Issued in April, the staffing regulation requires nursing homes to have registered nurses on site around the clock — something that the industry has endorsed — and to maintain minimum numbers of nurses and aides. Four of five homes would have to increase staffing. The requirements would be phased in, starting in May 2026.

Even before the election, many experts and activists had doubts that the rule would be effectively enforced, given the poor results in states that have imposed their own minimums. In New York, California, Rhode Island, and Massachusetts — states with the most robust requirements — many homes remain below the legal staffing levels. Governors have given many homes reprieves, and other homes have found that paying penalties costs less than the increase in payroll for additional staff.

The federal government estimates the average annual cost over a decade to meet the Biden mandate would be $4.3 billion a year, a 2 percent increase in expenses, though the changes do not include increases in federal Medicare or Medicaid payments.

“Staffing is everything in terms of nursing-home quality,” said R. Tamara Konetzka, a professor of public health sciences at the University of Chicago.

While the rule’s effectiveness was uncertain, she worried that repealing it would send the wrong message. “We would be losing that signal that nursing homes should try really hard to improve their staffing,” she said.

Advocate groups for nursing home residents, who had criticized the Biden administration rule for not requiring even higher staffing levels, have since pivoted and are trying to protect it.

“We’re hoping the president-elect will come in and take a look at the science and data behind it and see this really is a modest reform,” said Sam Brooks, the director for public policy for The National Consumer Voice for Quality Long-Term Care, a Washington-based nonprofit. “We’d be devastated to see it fall.”

The Trump transition team did not respond to a request for comment. The Department of Health and Human Services did not respond to requests for comment, but in a court filing it argued that nursing homes should be able to reach the required staffing levels.

“There is more than enough time to identify, train and hire additional staff,” the Biden administration wrote.

The quality of care in the nation’s 15,000 nursing homes and the lack of adequate staffing for their 1.2 million residents has been a concern for decades. Inspection reports continue to find homes leaving residents lying in their own feces, suffering severe bedsores and falls, contracting infections, choking on food while unattended, or ending up back in a hospital for preventable reasons. Some nursing homes overuse psychotropic medications to pacify residents because they do not have enough workers to attend to them.

Leslie Frane, the executive vice president of the SEIU, the Service Employees International Union that represents health care workers, said in a statement that “far too many nursing home owners will not do the right thing and invest in workers without oversight and binding regulation.”

The nursing home industry says many homes cannot afford to increase their workforces, and that even if they could, there is a scarcity of trained nurses, and not enough people willing to work as aides for an average $19 an hour. A registered nurse earns $40 an hour on average in a nursing home, less than what they could make at a hospital, according to the Bureau of Labor Statistics.

The Biden administration noted in its court filing it was planning to spend $75 million to recruit and train more workers, and that there were more than 100,000 workers who left nursing homes during the pandemic and could be lured back if salaries and working conditions were better.

How many nursing homes could afford the increased cost remains a mystery because of weaknesses in the government’s requirements for financial transparency. About half of homes lose money, according to their reports to Medicare, but some nursing home owners grow rich through clandestine maneuvers to siphon profits into their own pockets.

This month, owners of Centers Health Care, one of the New York state’s largest nursing home chains, agreed to pay $45 million to settle allegations by Attorney General Letita James that they diverted $83 million intended for resident care to themselves during the pandemic.

Maryellen Mooney, a spokesperson for the Centers Health Care chain, which denied the allegations, said in a statement that Centers was “committed to fully implementing the settlement terms, including a significant investment in resident care.”

The government estimated that about a fourth of the nation’s nursing homes would be eligible to apply for hardship exemptions if there were a documented shortage of nurses and aides in their communities compared with the national average.

But Nate Schema, CEO of the Good Samaritan Society, which runs 133 nonprofit homes mainly in the rural Midwest, estimated that only seven would be likely to qualify for a hardship waiver.

“Philosophically, they sound great,” he said, “but in practicality and how they’re put together, they won’t do much for us.”

This article originally appeared in The New York Times.