As an organization of bedside nurses, the Southern Arizona Nurses Coalition, an affiliate of the California Nurses Association, (SAZNC-CNA) applauds Arizona Rep. Bob Stump’s, R-9, declared commitment to safe, humane nursing home care in his April 16 Commentary for Arizona Capitol Times. [H2345 Boosts Quality of Arizona Nursing Home Care.]

Yet we are gravely concerned that his position and that of many other elected officials on H2345, permitting creation of training programs for nutrition and hydration assistants (NHAs) for use in nursing homes, are misguided. Contrary to Mr. Stump’s assertions, it is not so “difficult to fathom how a program designed to relieve a staffing crisis will exacerbate it.”

We believe H2345, already signed into law by Governor Napolitano, will further erode patient care in skilled nursing facilities and fragment nursing by permitting use of unlicensed, very minimally trained and compensated assistants to perform an important nursing task predominately carried out now by certified nursing assistants (CNAs). Elected officials enacted H2345 despite very compelling evidence against doing so.

H2345 and the new federal regulations released by U.S. Department of Health and Human Services (HHS) permitting use of NHAs run directly counter to findings in a 2002 HHS study of nursing home staffing. That research identifies nursing staff-to-resident ratios necessary to optimize care. The study concludes that unless a facility staffs at these levels, so called “single-task-workers,” such as NHAs, do not improve care. In addition, the study estimates 97 per cent of all nursing homes would fail to meet the identified minimum nurse staffing ratio.

AARP, the Alzheimer’s Association, the National Citizens’ Coalition for Nursing Home Reform and U.S. Sen. Chuck Grassley, a Republican from Iowa, and many others opposed the federal regulations permitting use of NHAs. Experts in nursing home care and advocates for the elderly recognize that nursing home residents would best be served by increasing staffing levels of already licensed and certified nursing personnel. “Adequate staffing and lack of professional supervision contribute to malnutrition, dehydration, and weight loss among nursing home residents,” according to Jeanie Kayser-Jones, a registered nurse who also holds a Ph.D, an expert in quality of care in nursing homes.

As many as 40 per cent to 60 per cent of nursing home patients have swallowing disorders that require proper knowledge of risks associated with feeding. Aspiration, inhaling food or liquid into the airway, can lead to pneumonia or asphyxiation. Studies indicate, however, that only one-fourth to one-fifth of residents with these problems have been evaluated by a professional. Contrary to Mr. Stump’s assertion then, NHAs may be assigned to feed residents with undiagnosed swallowing disorders.

Paid NHAs’ wages and benefits will be less than even certified nursing assistants (CNAs). Most CNAs in Arizona nursing homes do not make a living wage and receive meager or no benefits. Many work several other jobs. Often unable to provide the care they know their patients need and the security their families need, CNA job stress and frustration are high.

These conditions account for the 95.2 per cent CNA turnover rate in Arizona and the shortages that the industry claims necessitate use of NHAs. Yet rather than address the morally unacceptable working conditions and compensation that overwhelmingly contribute to morally unacceptable malnutrition and dehydration among nursing home residents, the industry is exacerbating the situation with creation of even more poorly compensated NHAs.

Contrary to Mr. Stump’s claim that feeding assistants will supplement not supplant CNAs, use of NHAs may easily displace CNAs because it will alleviate pressures on the industry to retain and recruit them. HHS and H2345 are not providing additional funding to hire even lower-paid NHAs. Neither HHS nor H2345 prohibit nursing homes from reducing the number of higher-paid CNAs. The result will be fewer CNAs available to provide other equally essential care, other than feeding, that NHAs cannot perform.

Replacing higher skilled with lesser skilled nursing personnel undermines safe, quality health care. Nursing home staffing levels and care are already severely compromised; the nursing shortage is a direct result of these conditions. Both H2345 and recently enacted H2256, a pilot project permitting unlicensed CNAs to administer medications in skilled nursing facilities, will further shortchange nursing home residents and current nursing personnel.—

Jane Black and Valerie Gomes are registered nurses and are coordinators of the Southern Arizona Nurses Coalition, an affiliate of the California Nurses Association.