Rhode Island’s politicians are happily proclaiming an ostensible gift that they are giving to Ocean State seniors with a law creating minimum staffing requirements for nursing homes.  Those who currently or may soon utilize such services have enough life experience to think more deeply about how the politicians are changing the terms of our representative democracy.  Four questions about the bill are worth mulling over.

First, who is going to pay for this?  The bill increases funding related for Medicaid patients, but that’s not everybody, and even if it were, the money has to come from somewhere.  Even if it were possible to do so, we can be confident that no real effort has been made to understand the consequences along those lines.

Second, is the state government of Rhode Island really the most competent entity to be running nursing homes?  Sure, the nursing homes themselves have administrative autonomy, but look at this level of detail:

Commencing on January 1, 2022, nursing facilities shall provide a quarterly minimum average of three and fifty-eight hundredths (3.58) hours of direct nursing care per resident, per day, of which at least two and forty-four hundredths (2.44) hours shall be provided by certified nurse assistants.

How can the government actually claim that a minimum number of hours to the hundreths of an hour is necessary in every circumstance across the state?  And going forward, who makes adjustments?  Answer: not the administrator tasked with keeping a specific building, with particular employees and unique clients, running:

On or before January 1, 2024, and every five (5) years thereafter, the department shall consult with consumers, consumer advocates, recognized collective bargaining agents, and providers to determine the sufficiency of the staffing standards provided in this section and may promulgate rules and regulations to increase the minimum staffing ratios to adequate levels.

Government bureaucracies, with heads appointed through a political process, will be making these minute decisions for every nursing home.  What makes anybody think that’s where authority should rest?

Third, what about innovation or individualized services?  Suppose either new technology or strategies come along that a nursing home staff thinks will help its residents, perhaps because of unique circumstances in that particular building.  They will either have to build it around this law (and the more-meddling laws that are sure to follow) or go through the arduous process of changing it through at least two legislative committees, two legislative chambers, and the governor — inevitably running into some special interest’s sacred cow.  (Look at the challenges facing charter schools.)

Finally, in summary:  Assuming that there is, indeed, a problem that more staffing might help solve, is this sort of ham-handed, fist-of-government approach really the way to solve it?

Featured image by Matthew Bennett.