TRENTON — Among the latest nursing home changes approved by the Legislature in the wake of the coronavirus pandemic is a bill establishing minimum ratios for the number of direct care staff working every shift.

The bill requires one certified nurse aide during the day shift for every eight residents. It had been stricter at 1:6 but was amended days before being approved. Bryn Lloyd-Bollard, communications coordinator for the SEIU 1199 union, said that was a compromise needed to get it through.

“We think these modified ratios are achievable, realistic, and they would represent a significant improvement for many facilities,” Lloyd-Bollard said.

The change has been long-sought by some lawmakers and the union representing long-term care facility workers, predating the pandemic. A version of the bill was passed by the Legislature in 2016 but was vetoed by then-Gov. Chris Christie.

Said Sen. Joe Pennacchio, R-Morris, said the problem with COVID deaths in long-term care isn’t about staffing but that the state allowed the virus into nursing homes and readmitted sick residents without providing adequate help. He pointed to an analysis in Florida that said other factors are more important to care.

“Very, very, very little of the outcome of the quality of care can be based on staffing,” Pennacchio said.

State long-term care ombudsman Laurie Facciarossa Brewer said her office hears daily from nursing home residents left in their beds unattended because there aren’t enough direct care professionals.

“Staffing is the single biggest problem we have. And we get calls every single day,” Brewer said.

The bill requires one certified nurse aide for every eight residents on the day shift. The ratio of direct care staff members to residents would be 1:10 for the evening shift and 1:14 for the night shift. Brewer does not anticipate recruiting problems once the “vicious cycle” of staffing shortages is broken.

“If the job is easier, is more manageable, because you have hard, fast ratios, then there are more people that are going to want to do this job,” she said.

The bill passed mostly along party lines, with Democrats in favor and Republicans – except for state Sen. Chris Brown, R-Atlantic – opposed.

“Fixed ratios are never a good idea because you don’t take into consideration the flexibility or the acuity of the mix of patients, of residents,” said Assemblywoman Nancy Munoz, R-Union, whose non-legislative career is in nursing. “It puts everybody in a bad situation.”

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The SEIU’s Lloyd-Bollard said state data shows about one-third of nursing homes already meet or exceed the 1:8 residents daytime ratio for certified nurse aides.

“So it’s time for the rest of the industry to follow their lead to maintain staffing standards that are necessary to provide quality care and attention to residents,” he said.

Michael Symons is State House bureau chief for New Jersey 101.5. Contact him at

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