Although participants were overwhelmingly pleased with Laura Cote's work providing behavioral consultation for nursing facilities, some noted that having only one person to cover the entire state did not allow adequate follow-up activities with facilities. With additional staff more inservices could be provided, response time could be shortened (although not considered a problem by facility staff contacted) and a greater degree of follow-up consultation could be provided.
The minimum staffing requirement, although no one would disagree that it was an important component to improving quality, was difficult for facilities to meet in view of the current nursing shortage in the state. Facilities reported having trouble finding an adequate number of qualified staff before the required staffing was increased and now frequently have to rely on temporary agency staff, a practice they feel does not contribute to quality of care. When initially proposed, the required staffing was discussed in the aggregate and not as ratios of direct care staff per shift. Facilities are reportedly being cited for numbers below the requirement. One facility stated they had been cited for staffing on the day shift of 5.06 residents per direct care worker when the requirement was 5.00 residents per staff person. Facilities also stated they would have preferred a greater degree of flexibility in the regulation so that they could staff according to their residents' needs--staffing even higher than required during certain peak times of the day and less when residents' needs were less intense.
Staffing below the required numbers is supposed to lead to a self-imposed moratorium on admissions. Facilities that are Medicaid certified must maintain a 90 percent occupancy rate to avoid having their funding affected. This creates a difficult situation where facilities must chose between regulatory and financial compliance.