McKee issues executive order to aid staffing issues at R.I. nursing homes

GOV. DANIEL J. MCKEE issued an executive order on Friday that would provide much needed staffing relief at the state's nursing home facilities. Pictured, registered nurse Sara Nystrom, of Townshend, Vt., prepares to enter a patient's room in the COVID-19 Intensive Care Unit at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., on Jan. 3. / AP FILE PHOTO/STEVEN SENNE

PROVIDENCE – Due to continued stresses caused by the COVID-19 pandemic, Gov. Daniel J. McKee issued an executive order on Friday that would provide much-needed staffing relief at the state’s nursing home facilities.

According to the order, which will remain in effect through Feb. 14, Rhode Island’s licensed health care facilities are experiencing workforce shortages due to pandemic stress, burnout and widespread resignations.

The governor’s order is aimed at preventing nursing homes from reducing capacity because they don’t have enough staff. The order suspends the requirement that a registered nurse be on call for 24 hours, replaced by requiring a registered nurse on the premises of each facility no less than 16 hours a day.

During those hours that a registered nurse is not on the premises, a licensed practical nurse shall be on premises with remote access to a designated on-call registered nurse.

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McKee said the temporary flexibility provided by this executive order will allow nursing home facilities additional time to hire staff while continuing to provide the appropriate level of care to residents.

“Nursing home facilities across Rhode Island, and the country, are facing unprecedented staffing challenges and financial instabilities exacerbated by COVID-19 – challenges that could not have been foreseen to this degree,” he said.

The governor said the order will help to ensure that nursing home facilities are not put in the position of reducing the number of residents in a facility to comply with the minimum staffing ratio, which would result in important health care resources being taken offline from the continuum of care needed to protect the health, safety and welfare of the residents.

“The safety and well-being of patients and residents in the state’s health care and long-term care facilities continues to be a top priority and the administration looks forward to continuing to engage with stakeholders as we work to reach a permanent staffing solution that benefits nursing home workers, residents and families,” McKee said.

The minimum staffing law, which began on Jan. 1, imposes significant penalties for nursing facilities that do not maintain the mandated hours per resident day of care by direct caregivers.

McKee’s office said the COVID-19 pandemic exacerbated major staffing challenges and significant financial instability that already existed at Rhode Island’s hospitals and health care facilities.

The order issued Friday noted that the pandemic has led to bed shortages at the state’s acute care facilities, including a shortage of available beds in nursing facilities needed for safe discharge of lower-acuity patients to an appropriate and necessary level of care.

The governor’s order noted that in recent months there has been an influx of patients who deferred necessary care during the height of the pandemic, requiring longer hospitalization. In recent weeks, the number of Rhode Islanders hospitalized with COVID-19 has dramatically increased.

The governor said that on March 9, 2020, a state of emergency was declared due to the public health dangers posed by COVID-19, and that order has been extended through at least Feb. 17, 2022.

Rhode Island is experiencing a high level of community transmission of COVID-19, defined as more than 100 cases of COVID-19 per 100,000 people in the past seven days. As of Friday, there were 2,196 new cases per 100,000 residents in the previous seven days.

The R.I. Department of Health projects the already high COVID-19 community transmission and hospitalizations in the state will continue to increase over the coming weeks.

On Nov. 17, 2021, a Rhode Island Health Care Association/Leading Age survey of 77 nursing homes reported: 1,920 open staff positions in Rhode Island nursing facilities, including 983 openings for nursing assistants and 447 registered nurse/licensed practical nurse openings; 28 facilities have closed units during the pandemic due to lack of staff; 23 facilities have closed to new admissions; and 71% of all facilities had limited admissions during the three months prior to the survey.

Cassius Shuman is a PBN staff writer. Contact him at You may also follow him on Twitter @CassiusShuman.

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