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Union Campaigns for Nursing Home Reforms

Care industry: Protest marchers hope to put pressure on governor. Report says staffing levels, violations are linked.


SACRAMENTO — Armed with a new study showing that understaffed nursing homes harbor widespread neglect, union leaders Tuesday began a campaign to pressure Gov. Gray Davis to reform the elderly care industry.

The report compiled by the Service Employees International Union showed that more state violations are found at homes with low staffing levels. Today the union is staging a protest march in the capital to push Davis on nursing care reforms. The governor promised his own set of reforms after vetoing a bill last year that had union and industry backing.

It also lands amid growing evidence that the raise Davis agreed to last year for nursing home workers--5% more than the median $7.12 an hour--has not been consistently passed on to employees.

The raise was to begin Aug. 1, for both nurses and certified nurse assistants, who provide an estimated 90% of hands-on care. But union workers report that many nursing homes are not paying or are paying far less than the promised amount--as little as 10 cents an hour.

"It's awful, especially when . . . it's required to be passed through," said Jorge Rodriguez, secretary/treasurer of the union's Los Angeles branch, Local 399. "Everybody's sitting on it and waiting to see how much they can keep."

The top nursing home lobby, the California Assn. of Health Facilities, blamed delays at many homes on confusion over the government guidelines. In addition, said Vice President Peggy Goldstein, the raise is only for the portion of a nursing home's budget that comes from MediCal, so workers will not get the full 5% raises unless their facility is 100% MediCal funded.

"People are very nervous, because once you change your wages, you can't undo it," Goldstein said. Compliance is "all over the board: Some people have done it, some people haven't. But they all have to eventually."

The governor has consistently indicated he would "consider it an act of bad faith" if nursing homes were not turning over the increase to workers.

"The purpose of this money was to compensate some of the least paid but most valuable people in our society," he said during an interview earlier this year. "If it wasn't used for that purpose, you'll have a governor who's ticked off."

The state has established a mechanism for auditing and fining nursing homes that do not provide the raises, but that process does not begin until July.

"They have the opportunity to do the right thing between now and then and hopefully they will," governor's spokesman Michael Bustamante said Tuesday.

Part of Davis' plan for improving nursing home conditions is to increase options for the elderly and infirm to stay in their own homes. But he also added 200 nursing home investigators through his budget last year and reiterated that he would be considering ways to further increase pay and training of workers this year.

A second 5% raise is included in the governor's proposed 2000-2001 budget.

In large part, his stated goals mirror those of the Service Employees International Union, which has been trying to organize nursing home workers for several years and now represents about one in 10.

Basing its conclusions on state and federal health data, the union report "Behind the Headlines" indicates that the median staffing in California nursing homes is fewer than three hours daily of direct care per resident, well below recommended safe staffing levels of more than four hours.

In 1997, the median number of state violations at all nursing homes was 10, while the median for nursing homes where residents received 3.2 hours of care per day was 8 violations that year. The median for those that met the recommendation of 4.13 hours was just three violations--far fewer than the statewide median.

Expressed in patients' terms, the best staffed nursing homes reported half as many bed sores as the poorly staffed ones and half as much incontinence, simply because staff members had time to take patients to the bathroom more frequently.

In addition, facilities with the highest staffing had the lowest staff turnover--about 50% a year compared with 69% of those with fewer employees.

In its recommendations, the union urges Davis to:

* Follow through on his recommendations to study nursing home staffing ratios, with an eye toward establishing minimum levels to provide more than the 3.2 hours required beginning this year. (The industry agrees staffing should be higher, but prefers it to also be more flexible, related to patients' needs.)

* Increase funding and safeguards to ensure that the 5% raise gets to workers and consider a sliding scale that rewards nursing homes that have bigger staffs and better wages with higher Medi-Cal reimbursement.

* Improve oversight of nursing homes, including more vigorous assessment and collection of fines for understaffing.

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