Senate Bill No. 426
(By Senators Dempsey, Hunter and White)
[Introduced February 3, 2003; referred to the Committee on Health
and Human Resources; and then to the Committee on Finance.]
A BILL to amend article five-c, chapter sixteen of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, by
adding thereto seven new sections, designated sections twenty
through twenty-six, inclusive, all relating to nursing homes;
requiring adequate staffing; specifying certain staff to
resident ratios; providing enforcement provisions; including
civil penalties; requiring a study committee; providing
enhanced training requirements for nurse aides; and providing
a grant program for projects aimed at reducing employee
turnover in nursing homes.
Be it enacted by the Legislature of West Virginia:
That article five-c, chapter sixteen of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, be
amended by adding thereto seven new sections, designated sections
twenty, twenty-one, twenty-two, twenty-three, twenty-four, twenty-five and twenty-six, all to read as follows:
ARTICLE 5C. NURSING HOMES.
§16-5C-20. Legislative findings.
The Legislature finds and declares:
(1) There is a large and growing population of senior and
disabled persons who require nursing facility care;
(2) Significant staffing resources are necessary to provide
quality care to our senior citizens and people with disabilities
who reside in nursing homes;
(3) Nursing homes which receive public money should be
required to provide at all times staffing resources to meet the
minimum levels necessary to provide quality care to each resident;
(4) Nursing homes which receive public money have a
responsibility to report to residents, their families and to the
taxpayers of the state, the staffing levels that they provide for
the residents in their care.
§16-5C-21. Definitions and scope.
(a) For purposes of sections twenty through twenty-five of
(1) "Licensed personnel" means registered professional nurses
and licensed practical nurses.
(2) "Direct caregivers" means certified nurse assistants,
licensed practical nurses and registered professional nurses.
(3) The minimum standards and rations provided in section twenty-two of this article apply to all residents, regardless of
their payment source. No waiver of these standards is allowed.
(4) A registered professional nurse as nursing supervisor on
duty at all times twenty-four hours per day, seven days per week.
(b) A long-term care facility shall maintain a ratio of
licensed personnel to residents of no less than:
(1) One to fifteen during the morning shift;
(2) One to twenty during the afternoon shift; and
(3 One to thirty during the night-time shift.
(c) A long-term facility shall maintain a ratio of direct
caregivers to residents of no less than:
(1) One to five during the morning shift;
(2) One to ten during the afternoon shift; and
(3) One to fifteen during the night-time shift.
(d) An employee designated as a member of the nursing staff
may not provide services which include food preparation,
housekeeping, laundry or maintenance services. A person employed
to provide services which include food preparation, housekeeping,
laundry or maintenance services may not provide nursing care to
residents and may not be counted in determining ratios pursuant to
subsection (c) of this section.
(e) The ratios outlined in this section are minimum standards
only. Nursing homes shall employ additional staff if needed to
ensure quality resident care.
§16-5C-22. Study committee.
(a) Beginning the first day of July, two thousand three, and
every five years after that, the joint committee on government and
finance shall appoint a committee that shall at a minimum, include
consumers or their advocates, or both, workers or their
representatives, or both, and providers. The committee shall
conduct a study to assess whether the staffing ratios and standards
outlined in this section are sufficient to meet residents' needs.
If the staffing ratios and standards are insufficient, the
committee shall make recommendations to the joint committee on
government and finance on how the ratios should be adjusted.
(b) The committee shall contract with experts in the field of
nurse staffing research and long-term care to recommend a
methodology for determining appropriate levels of staffing based on
acuity. Nursing homes are required to adjust caregiver to resident
ratios upwards, according to this methodology in order to meet the
needs of residents with higher acuity levels or those requiring
§16-5C-23. Disclosure; public right to staffing information.
(a) A nursing home shall post for each wing or floor, or both,
of the facility and for each shift the current number of licensed
and unlicensed nursing staff directly responsible for resident care
and the current ratios of residents to staff, which show separately
the number of residents to licensed nursing staff and the number of residents to direct caregivers. This information shall be
displayed on a form supplied by the director.
(b) The information shall be posted for the most recently
concluded cost reporting period in the form of average daily
staffing ratios for that period. This information must be posted
in a manner which is visible and accessible to all residents, their
families, caregivers and potential consumers in each facility. A
poster provided by the director which will describe the minimum
staffing standards and ratios shall be posted in the same vicinity.
§16-5C-24. Enforcement; civil penalties.
(a) The director shall impose a civil monetary penalty upon
any facility that fails to meet the staffing requirements set forth
in sections twenty through twenty-five of this article. The
penalty shall be imposed for each day on which the failure occurs.
(b) The amount of the penalty shall be determined as follows:
(1) Penalties in the range of three thousand fifty dollars to
ten thousand dollars per day shall be imposed for deficiencies in
staffing which constitute immediate jeopardy to resident health or
safety and for repeat deficiencies when a monetary penalty has been
(2) Penalties in the range of fifty dollars to three thousand
dollars per day shall be imposed for deficiencies in staffing which
do not constitute immediate jeopardy to resident health or safety.
(c) In addition to the penalty set forth in subsections (a) and (b) of this section, in any action brought by or on behalf of
a resident of the facility, his or her heirs or assigns, for
intentional or negligent infliction of harm or lack of adequate
care, it shall be established that a failure to meet the staffing
requirements of section twenty-two of this article was a
contributory cause of any injury sustained by the resident.
(d) The director shall impose a civil monetary penalty upon
any facility that fails to meet the posting requirements set forth
in section twenty-four of this article. The penalty is one
thousand dollars and shall be imposed for each day upon which the
facility failed to meet fully the posting requirements.
(e) All civil penalties collected by the director shall be
deposited in the state treasury to the credit of the general fund.
§16-5C-25. Nurse aide training requirements.
(a) The Legislature finds:
(1) Federal regulations established by the Omnibus Budget and
Reconciliation Act of 1987 require that certified nurse aides in
nursing homes complete a minimum of seventy-five hours of training.
Since one thousand nine hundred eighty-seven, the nursing home
population has changed dramatically. Residents now have much
higher acuity levels than in the past and many more have dementia.
As a result, the job responsibilities of certified nurse aides are
increasingly complex. Experts agree that the training requirements
are not sufficient to prepare certified nurse aides to serve this changed population. Many states have instituted training
requirements for certified nurse aides that are more stringent than
the federal seventy-five hour requirement.
(2) In addition to inadequate training for the direct care
workforce, astronomically hiqh employee turnover rates jeopardize
the quality of care for nursing home residents. According to a
recently published survey conducted for the American health care
association, the average annualized turnover rate for certified
nurse aides in West Virginia nursing homes is nearly seventy-eight
percent, higher than the national average of seventy-six percent.
(3) To protect West Virginia residents, the state should
increase the amount of training required, improve the training
curriculum and establish a competitive grant program to encourage
innovative programs to reduce turnover.
(b) (1) The secretary of the department of health and human
resources shall increase the amount of training required for
certified nurse aides to one hundred sixty hours of training. This
amount shall include seventy-five hours of classroom training and
eighty-five hours of supervised practical training.
(2) To improve the quality of instruction, approved training
for certified nurse aides, the secretary shall require a ratio of
no more than twenty-four students to one registered nurse
instructor for classroom training, and eight students to one
licensed nurse for supervised practical training.
(3) The secretary shall modify curriculum requirements for
state approved nurse aide training programs to include more focus
(A) Technical skills needed to prevent malnutrition and
(B) Social skills necessary to prevent abuse such as conflict
(C) Stress management and diversity training; and
(D) More thorough training on skills needed to address the
unique needs of individuals with dementia.
(4) The secretary shall, in addition to the one hundred sixty
hours of training required for certification, require all first
time certified nurse aides to undergo a one-week orientation with
a mentor. During the orientation, the certified nurse aide may not
have unsupervised contact with residents. Certified nurse aides
who have been in good standing for a minimum of three years are
qualified to be designated as mentors.
§16-5C-26. Grants for employee retention programs.
(a) The secretary shall establish, from funds appropriated for
the program or other available funds, a competitive grant program
to assist in reducing employee turnover in nursing homes. The
program shall, at a minimum provide:
(1) The award of grants to partnerships for two-year periods;
(2) The grants may be used to:
(A) Establish labor management committees;
(B) Establish specialized training programs above and beyond
the one hundred sixty hour requirement;
(C) Provide wage increases for certified nurse aides who serve
(D) Establish career ladder programs;
(E) Improve workplace safety; or
(F) To assist in implementing other initiatives to reduce
turnover and improve resident care, as approved by the secretary.
(b) (1) The secretary shall appoint a volunteer advisory
council to review applications and make recommendations to the
secretary as to which should be funded. At a minimum the council
shall be composed of individuals appointed to represent:
(A) Nursing facility management;
(B) Consumer interests;
(C) Worker interests; and
(D) Non-profit or public organizations specializing in
(2) A majority of the representatives on the council must be
individuals representing non-management interests.
(3) For purposes of this section an individual representing:
(A) Consumer interests may include the ombudsman responsible
for the region, a family council representative or other individual
approved by the residents as representing their interests; and
(B) Worker interests is the collective bargaining agent or
other democratically elected representative of the direct care
(c) (1) To be eligible to receive a grant, a partnership shall
submit an application in the manner prescribed by the secretary.
(2) The application must illustrate that the proposal has been
developed in consultation with and approved by nursing facility
management, consumer and worker representatives in the facility or
facilities in which it is intended to be implemented.
(3) Applications submitted by unionized nursing facilities
must submit a letter of support from the collective bargaining
agent for that facility.
(4) Eligible partnerships include nursing facilities, labor
organizations or joint efforts of both entities. Partnerships may
cover more than one facility if the eligibility requirements are
met for each facility.
(5) Each eligible entity that is awarded a grant shall submit
a mid-term report after one year of the grant cycle and a final
report within thirty days of the completion of the grant cycle to
the secretary and the advisory council.
NOTE: The purpose of this bill is to provide for the adequate
staffing of nursing homes and training of nursing home staff.
All sections in this bill are new; therefore, strike-throughs
and underscoring have been omitted.