California delays start of stricter nurse-patient ratio law.

As California's acute care hospitals start a three-year reprieve from implementation of a tougher nurse staffing law, their cousins in the long term care industry are watching from the sidelines to see if a trickledown effect reaches their facilities.

The state's 450-plus acute care hospitals were to begin using a 1-to-5 nurse-to-patient ratio this month down from 1-to-6, as part of a law signed in 1999 by then-Gov. Gray Davis. According to John Gilman, a consultant on the California State Assembly Committee on Health, the law made California the first state to mandate nurse-to-patient ratios in all hospital units.

With the backing of current Gov. Arnold Schwarzenegger, however, the state Department of Health Services suspended the ratio requirements until January 2008 because it would place too heavy a financial burden on facilities, according to California Director of Health Services Sandra Shewry. "We do not yet understand the impact of these groundbreaking ratios on the state's fragile healthcare delivery system;' Shewry said. "(Therefore), we must move forward cautiously."

Not having enough nurses in acute care could also create an added burden on long term care facilities, predicted Ingwela Dahlgren, a Southern California chapter president for the Service Employees International Union. "You're going to have people in long term care who might not have ended up there if there had been enough nursing staff at our level. It's going to cost taxpayers so much more money and put an enormous strain on the entire (health care) system."

The California Healthcare Association, the state's largest lobbyist for medical facilities, applauded the change. The association argued for more than a year that the law was too strict and would cause staff-short hospitals to close or reduce patient admissions in order to meet the staffing ratios, according to CHA spokesperson Jan Emerson. "This is a step in the right direction," Emerson said. "Millions of Californians were at risk of losing their patient care."

Meanwhile, the California Nurses Association, one of two major nurses' organizations to support the law, gave the delay a thumbs-down. According to CNA President Deborah Burger, the staffing law helped bring more than 43,000 new registered nurses into California medical facilities since 2000. "This irresponsible public policy could actually exacerbate the nursing shortage at a time when those hospitals that have complied with the law have seen their vacancy and turnover rates sharply fall," Burger said.

Rebecca Cohn, chair of the State Assembly Committee on Health, called the change "a rash and unwarranted move at this time."

Kim Belshe, secretary of the state's Health and Human Services agency, defended the delay. During a news conference, she said the current staffing ratios were safe for patients and that their safety "is a top priority for this administration."

The "Safe Staffing Law," authored by now-state Sen. Sheila Kuehl, applies only to acute care facilities and even excludes the sections of hospitals that contain long term care beds, according to CNA Regulatory Specialist Vicki Bermudez.

But a similar law authored by then-Assemblymember Kevin Shelley and signed by Davis in 2001 establishing nurse-patient ratios in skilled nursing facilities awaits full implementation. The state is still ironing out the proper ratios, according to Jack Christy, director of public policy for the California Association of Homes and Services for the Aging.

The concern is whether delayed implementation of the Safe Staffing Law will reflect what happens with implementation of the skilled nursing facility ratios--whenever it occurs, said SEIU's Dahlgren.

"I can tell you from past experience that this will happen, because that's how the industry works," Dahlgren said. "If they figure out that something works on one end, they will implement it on the other."

Not everyone agreed with that assessment, however. "So far, there has been no indication that the state won't move forward with those ratios," Christy said. "Nevertheless, the same nursing shortage will affect implementation of those ratios."