LISTEN: The Georgia Department of Community Health will not move ahead with a proposed rule change on staffing in the state's certified dementia care facilities. GPB’s Ellen Eldridge reports on the impact of the outcry over the proposed changes.

A group of advocates with signs supporting nurse to patient staffing minimums.

People protest outside the White House in Washington, Thursday, May 12, 2022. The healthcare workers' organizations said they are planning this event to fight for fair and realistic wages for nurses, safe staffing environments, no violence against healthcare workers, and changing the culture of the biases and discrimination in the nursing profession.

Credit: (AP Photo/Susan Walsh)

The Georgia Department of Community Health has decided not to move ahead with a proposed rule change on staffing in the state's certified dementia care facilities. 

In 2020, organizations including the Georgia Council on Aging and the Alzheimer's Association advocated on behalf of Georgia residents, families, and caregivers to successfully pass a bill that strengthened staffing requirements in nursing homes and increased maximum fines for violations.

Rep. Sharon Cooper said she proudly co-sponsored the legislation with Sen. Brian Strickland to protect the most vulnerable, institute common-sense reforms, and ensure those working in these facilities receive the training that they need to care for elder Georgians.

The legislation "will improve the lives of countless people in our great state and bring tremendous comfort to their loved ones," Gov. Brian Kemp said as he signed the bill into law.

Similarly, President Joe Biden pledged that his administration would “protect seniors’ lives and life savings by cracking down on nursing homes that commit fraud, endanger patient safety, or prescribe drugs they don’t need.”

A federal mandate from the Biden administration means nursing home owners cannot slash staffing to unsafe levels, according to a White House statement.

"When nursing homes stretch workers too thin, residents may be forced to go without basic necessities like hot meals and regular baths, or even forced to lie in wet and soiled diapers for hours," the statement says. "Residents also suffer avoidable injuries like falls and bedsores. Workers become burnt out from the daily struggle to deliver the quality care they know their residents deserve."


'Mandates make it worse'

Mandates worsen the problem, said Chris Downing, president of the Georgia Health Care Association, a nonprofit association of skilled nursing centers, assisted living communities, and home and community-based case managers.

Downing said GHCA conducted a study that found a federal staffing mandate would mean Georgia nursing homes would need to hire an estimated 3,652 additional full-time employees (2,754 nurse aides and 898 registered nurses), during the worst health care workforce shortage Downing has seen in more than 25 years.

The rule will cost Georgia nursing homes approximately $187 million per year, he said, partly because 76% of nursing homes in the state are currently not meeting at least one of the three staffing requirements.

Additionally, two rules proposed to DCH last December would change the minimum staffing requirements for 24-plus bed personal care homes and assisted living communities.


'Unequivocally against the proposed change'

An old person being pushed in a wheelchair

The Georgia Department of Community Health will not move ahead with a proposed rule change on staffing in the state's certified dementia care facilities.

Credit: Pexels

The Alzheimer's Association's Georgia chapter released a statement saying the organization is unequivocally against this proposed change.

In Georgia, 42% of residents in assisted living communities have dementia. In memory care, that number is 100% of residents.

The chapter's director of government affairs, Nancy Pitra, said the proposed changes would permit memory care units to staff only one direct care worker in residences where people with dementia live and are at risk of wandering away.

The same advocacy groups, industry representatives, and legislators spoke up this year during the public comment period. Gerontology professors across the state sent in written comments, and people certified to do training around dementia education for facilities commented. Law enforcement representative also show up for oral hearing, Pitra said.

"When it came down to it, I think there were such strong public support for the current roles and strong public support to not reduce staffing minimums that the department, they made the right decision and they decided not to move forward with any revisions at all to the current staffing for assisted living communities, memory care specifically," Pitra said.



Devon Barill emailed a statement on behalf of GHCA, saying the organization is disappointed that the rule change for assisted living communities and personal care homes was not finalized.

"We were supportive of the rule change, which would not have reduced the number of staff that would be available to residents requiring memory care but would allow for required staff to be present in the facility and available for timely access rather than being physically present in the memory care community at all times," Barill said. "We believe the initial rule exceeded the intent of the legislature with the inclusion of stringent language that discourages innovation in care delivery models and inhibits center leadership to make operational decisions based upon the unique characteristics of the greater community and population served."

Considering the rapidly growing aging population and an increasing prevalence of dementia amid an ongoing workforce crisis that is only expected to worsen in the coming years, GHCA said in its statement that access to specialized memory care for seniors needing those services may be negatively impacted in the future.

"The current rules are operationally prohibitive and constrain the evolution of person directed care," Barill said. "GHCA urges all stakeholders to prioritize quality of care and quality of life and engage in meaningful dialogue to innovatively meet the needs of Georgia’s deserving seniors."


A previous version of this article included incorrect references to regulation of staffing in nursing homes.