Contact the Governor - Say No to Staff Ratios!

For Immediate Release
June 14, 2017

Sacramento  - Late in the evening on June 8, the Budget Conference Committee surreptitiously voted to support a last minute proposal from the Department of Finance that requires nursing homes to institute a 2.4 certified nursing assistant (CNA) staffing ratio and 3.5 minimum staffing level by July 1, 2018.  The Health Care Trailer Bill includes this significant policy change with a $30 million General Fund  price tag with little to no public discussion, nor does it recognize the tremendous impact this will have on patient access to care. 

 DOF Proposal will harm nursing homes that utilize more licensed nurses
The administration’s proposal to institute a 2.4 CNA staffing ratio is a harmful, one-size-fits-all approach that is not based on patient acuity and that favors lesser qualified staff over licensed nursing care.  Nursing homes are already struggling to find the CNAs necessary to meet the current 3.2 nursing hours per patient day requirement.  By instituting an additional 2.4 CNA staffing ratio, nursing homes will need to hire over 2,000 more CNAs even if they already meet the new minimum standard of 3.5 minimum nursing hours per patient day with higher level nursing staff.

DOF proposal is underfunded and not workable
The DOF estimates that it will only cost the Medi-Cal program $10 million in General Fund dollars to move 900 facilities into compliance with the new law in one year.  The administration has not calculated nor understands the depth and extent to which this new requirement will impact current nursing facility staffing patterns and patient access to care.  CAHF estimates that there will be a cost of at least $30 million GF cost to the Medi-Cal program. 

 CMS opposes nursing home staffing ratios
The one-size-fits-all standard mandated by the DOF language in the healthcare budget trailer bill is not a proven nor recommended approach with respect to dealing with the individual patient acuity needs in nursing homes.  In fact, an attempt to implement this proposal at the federal level was shut down by CMS and the Obama Administration in 2016.  Today, SNFs must meet daily minimum nursing hour requirements at each facility – along with CMS’s requirement for staffing based on individual patient need.  This patient care approach is far preferable to mandated staffing ratios, and it is far more reasonable from a state expense perspective.

Nursing home workforce challenges must be addressed
In addition, the DOF nursing home staffing ratio proposal does not take into account the very challenging task of finding such a large number of trained CNA personnel to meet the new, strict staffing provisions.  The new CNA mandates would require our SNFs to employ thousands more CNAs, who do not exist in the workforce on such a large scale. This proposal is a workforce impracticality and as such, it will directly lead to increased liability for SNFs that cannot meet the new staffing mandate.  SNFs will be forced to reduce their bed availability having a dramatic impact on patient access to long term care.

  • CALL THE GOVERNOR’S OFFICE  916-445-2841

  • TWEET YOUR CONCERNS AT @CAHFUPATES. MENTION @JerryBrownGov   Use the hashtags #dontplaypolitics #nostaffratios

Tell him a one-size-fits-all approach harms patient care!

Sample messages 

My SNF cares for XXX patients.  Patients deserve quality care and outcomes. #DontPlayPolitics #SayNoToRatios
My SNF cares for XXX patients.  I staff accordingly, not arbitrarily. #DontPlayPolitics #SayNoToRatiosMy SNF cares for XXX patients. 
Money should be responsibly invested in their quality care. #DontPlayPolitics #NoStaffRatios

For additional information, contact Amy Blumberg at CAHF at (916) 432-5205 or