Report of the Commission on Health Care Facilities in the 21st Century
Testimony before the State Senate Health Committee on the Report of the Commission on Health Care Facilities in the 21st Century, December 1, 2006.
Good afternoon. My name is Shaun Flynn and I am an associate director for governmental affairs for the New York State Nurses Association.
When the group now called the “Berger Commission” was created by law in late 2005, NYSNA raised concerns about its purpose and function. The Commission was based on the presupposition that hospitals and nursing homes needed to “right-sized.” While it would be logical to conduct a needs assessment and collect data to determine whether closures and downsizing were needed, the commission was given a foregone conclusion and then charged to find data to support it.
NYSNA members spoke at many of the regional public hearings. At the time, they were struck by the lack of public involvement and input. Members of our staff attended each meeting of the Commission itself, but found that most of the deliberations took place behind closed doors. More transparency is needed in creating recommendations that will have far-reaching impact on health care in our state.
The result, as could be expected, is a flawed document which, if implemented, will hurt more than it heals. NYSNA urges the State Legislature to reject these recommendations and use this opportunity to undertake a comprehensive review of the state’s healthcare delivery system. Our concern now is that state leaders will implement these recommendations as a “quick fix” and fail to analyze and take action on other issues that have a more far-reaching impact on health care and health care costs.
We disagree with the statement in the report’s executive summary that “a fundamental driver of the crisis in our healthcare delivery system is excess capacity.” Without any documentation, the report claims that “hospitalizations expand in relation to the number of available beds” and accuses hospitals of admitting patients solely to generate revenue. This is a serious charge, which is not supported by the experiences of our nurse members.
We have identified the following major problems with the Commission’s report:
- The recommendations concern only hospitals and nursing homes.
The continuum of care extends beyond these facilities to home care, ambulatory care, psychiatric facilities, and so on. These settings must be included in any plan to revamp our state’s healthcare system. It is impossible, for example, to urge that nursing home beds be closed without a corresponding recommendation for ways to expand and improve noninstitutional care for the elderly, disabled, and mentally ill.
- The report appears to assume that certified beds are staffed beds.
In the facilities where our members work, nurses are not twiddling their thumbs, staring at empty patient beds. Rather than being overstaffed, hospitals and nursing homes are often woefully understaffed. A report released last January by Governor-Elect Spitzer found that a majority of nursing homes in the state were staffed below federal guidelines. Thousands NYSNA members have filed protests over the past five years claiming that their patient load was too high and they were concerned about being able to provide safe care.
- The report does not address the inevitable displacement of nurses and its effect on the nursing shortage.
Closing and downsizing facilities will result in nurses losing their current jobs. We expect that as many as 1,500 of our members will be displaced if these recommendations are implemented in full. This does not take into account the displacement of thousands of nurses who do not belong to NYSNA. We know, based on our experience with downsizing in the mid-1990s, that many of these nurses will simply leave bedside care. Registered nurses are skilled professionals. Many are certified in a nursing specialty. In order to move into other acute-care positions, they will require education – not just “retraining” – to perform effectively in a new role. Unless there is a program in place to meet the unique needs of these nurses, they will be lost to the profession and the nursing shortage will worsen.
- The report appears to be biased in favor of privately operated facilities.
By recommending that public facilities merge with private ones, the report ignores the vital role played by publicly operated hospitals and nursing homes. These facilities allow government to fulfill its responsibility to ensure that the needy, the uninsured, and the underinsured are not left without care. Back in the 1970s, when AIDS patients were being turned away from private hospitals, public hospitals admitted them and cared for them. Public healthcare facilities are a safety net we can’t afford to lose.
- The recommendations have the greatest impact on community hospitals.
As has been noted in the media, small hospitals rather than large corporations have been targeted for closure. These facilities, such as Cabrini Medical Center in Manhattan and Westchester Square Medical Center in the East Bronx, serve unique populations. Both have voluntarily taken steps to improve their financial viability and focus on needed services. It makes no sense to claim huge savings from closing these hospitals, when the impact on jobs and the economy in nearby communities will put added demands on the state’s welfare and Medicaid systems.
Finally, registered nurses are patient advocates. Our members don’t sit at conference tables looking at statistics and financial reports. Nurses see patients. They know the elderly woman who has trouble getting a ride to the hospital and can’t afford a taxi. They know the young immigrant mother who brings her asthmatic child to the emergency room in the middle of the night. They know the “working poor” who postpone getting care because they can’t afford medications and treatments.
Is $300 million a year in federal money worth the loss of a few lives? If it is, how many lives are acceptable to state legislators? NYSNA maintains that if one person loses access to care because of these recommendations, the cost outweighs the benefit.
NYSNA and its member urge state government to make the tough decisions that will truly reform health care and reduce costs:
- Create a system of universal healthcare coverage in New York to make affordable care available to everyone – one of the policy recommendations made by the Commission itself. It has been demonstrated in national studies that health coverage based on private, for-profit insurance companies is horribly expensive and does not improve the quality of health care.
- Invest in ensuring an adequate nursing workforce now and in the future. Nurses are the most numerous healthcare providers and shortages lead to more patient complications, longer hospital stays, and higher costs.
- Develop an effective system for monitoring the quality of care provided in hospitals and nursing homes and reporting the results to the public. Of particular value are patient outcomes that are specifically related to nursing care.
Thank you for the opportunity to submit testimony. NYSNA looks forward to working with the legislature to take the steps necessary to make health care in New York a model for the nation.
For more information, contact Governmental Affairs at 518.782.9400, ext. 283 or by e-mail.