Help Shortage May Affect Nursing Home Rules

The nationwide shortage of nurses could frustrate a federal government proposal--already under attack for its potentially high cost--to improve nursing home care by requiring operators of the homes to increase training and staffing levels, industry officials said Monday.

The proposed regulations drawn up by the Department of Health and Human Services have not yet been fully disclosed. However, agency officials have said that, in general, the proposed rules call for nursing homes--in order to receive federal assistance--to hire additional employees, provide more training and employ round-the-clock licensed nurses. The department estimates that the requirements could cost the industry more than $100 million a year.

Although industry officials expressed some concern about the potential cost of the proposed rules, they said they were even more concerned about finding trained nurses at any price.

“One of our real concerns is the resource pool that is available to meet the needs,” said Jack McDonald, vice president of Beverly Enterprises, the nation’s largest investor-owned nursing home chain. “It’s not just a question of the availability of funding but also of finding trained personnel,” he added.

“There’s a nursing shortage for everyone right now--hospitals and the like--not just nursing homes,” added Randall Huyser, a health-care analyst with the Montgomery Securities investment house in San Francisco. What’s more, Huyser said, “Profit margins (in the nursng home industry) are razor thin.”

Even union officials, who have long been in favor of nursing home reform, said the nursing shortage may pose a significant obstacle to industry compliance.

“The nursing shortage has got to be addressed,” said Gerry Shea, director of the health-care division of the Service Employees International Union in Washington.

The nation’s more than 25,000 nursing homes employ about 1.2 million people, including 83,300 registered nurses, 120,000 licensed practical nurses and 501,000 nurses’ aides, according to the National Center for Health Statistics.

But recruiting additional skilled nursing help has become more difficult in recent years because of a narrow salary range that discourages nurses from spending a career in the profession. As a result, the number of available jobs for licensed nurses more than doubled--to 13.6% of the total number of nursing jobs from 6.5%--between 1985 and 1986, according to the American Hospital Assn.

Industry officials expressed less concern over the remaining proposed rules, saying that several states, including California, already impose tougher standards than are being proposed by the Department of Health and Human Services.