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The New York state Capitol in Albany

ALBANY — With the lives of more than 15,000 New York nursing home residents lost to COVID-19 infections, lawmakers are preparing to advance measures that are aimed at driving more funds to patient care and holding owners accountable for deviating from safety standards.

A proposal to require mandatory staffing levels is already drawing strong resistance from both the nursing home industry and the hospital lobby. They argue such a mandate could drive some health care providers out of business and place onerous requirements on employers at a time when nurses and medical aides are in short supply.

But Assemblyman Richard Gottfried, D-Manhattan, chairman of the Assembly Health Committee, said he is optimistic that measure and others will get serious consideration in light of support for mandatory staffing levels in a report last month by state Attorney General Letitia James on nursing home deaths. While James found the state significantly undercounted the deaths by not including fatalities of nursing home residents who died at hospitals, she also made several recommendations for improving care at the facilities.

The so-called "safe staffing" measure, Gottfried said, "ought to be a given at this point."

Gottfried and state Sen. Gustavo Rivera, D-the Bronx, the chairman of the Senate Health Committee, are putting the finishing touches on a measure that would direct nursing homes to spend a prescribed percentage of their total revenue on resident care.

That would lead to the facilities spending more on staffing, Gottfried said, noting the proposal would block them from including any expenses associated with use of employment contractors to provide the labor.

"The point is to make sure that resources are actually spent on resident care," he said.

Advocates for nursing home resident have joined with the politically influential Service Employees International Union 1199 to promote a package of proposals addressing what they call "deficiencies" that they say have worsened the pandemic's impact on the facilities.

Along with the union, the Long Term Care Community Coalition and AARP/New York are insisting that the state improve infection control enforcement at the facilities and prevent "poor performing" owners from purchasing additional facilities.

They ae also backing the call by Gottfried and Rivera for the homes to be required to spend a "significant" share of revenue on resident care.

“The pandemic has exposed longstanding failures to ensure that New York families can count on their nursing homes for safety and treatment with dignity,” Richard J. Mollot, Director of the Long Term Care Community Coalition, said.

In the course of the debate, the nursing home industry is expected to make its case that the best ways to improve the level of care is to increase Medicaid funding for the facilities and blaze new career paths at community and state colleges for those endeavoring to work in health care.

"The low tide point of the pandemic has brought to light the fact that for the past 12 years the state has cut Medicaid funding to nursing homes," said Stephen Hanse, president of both the New York State Health Facilities Association and the New York State Center for Assisted Living.

The state's current cost of 24-hour care at the facilities stands at $266 per day, while Medicaid reimbursement, on average, covers only $211 of that expense, Hanse noted.

"We'd argue folks are paying more for their babysitters than they do for nursing homes," Hanse said.

He also warned that some of the proposed mandates being discussed by lawmakers would push costs up so high that some homes would be forced to shut their doors.

"Nursing homes are in dire financial straits," Hanse said. "What we are seeing are knee-jerk politicized reactions that seek to blame the nursing homes for the consequences of the virus."

Hanse and state Health Commissioner Howard Zucker are among those expected to testify at budget hearing Thursday focusing on state health care programs.

Gov. Andrew Cuomo signaled Friday he wants to see nursing home reform measures included in the state budget, including one that would increase civil fines to $25,000 for violations of the Public Health Law and streamline the process for appointing a receiver to oversee a facility.

Cuomo said he also wants the facilities to spend at least 70% of revenue on direct patient care, with a minimum of 40% of revenue going to staffing.

The governor's administration is facing a federal investigation arising from the undercount of nursing home deaths. Cuomo has insisted the state accurately reported the total number of COVID-19 deaths while acknowledging its reports did not initially count fatalities as nursing home deaths in cases where the residents died while being treated at hospitals.

Joe Mahoney covers the New York Statehouse for CNHI’s newspapers and websites. Reach him at

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