Residential Care Services and stakeholders, including LeadingAge Washington, WHCA, SEIU and the State Ombuds office, continued earlier conversations regarding the department’s legislative proposal to continue the 24/7 RN Staffing exception process.

By way of background, in 2016 when the minimum staffing level mandate in RCW 74.42.360 went into effect, it was stipulated that after June 30, 2019, the department, along with a stakeholder workgroup established by the department, would conduct a review of the 24/7 RN exceptions process, for facilities with 60+ beds, to determine if it is still necessary.  All stakeholders acknowledged that the exception process was still necessary and that it would likely continue to be necessary well into the foreseeable future given the nursing shortage facing our state and country. 

The department has narrowly interpreted RCW 74.42.360 and concluded that without legislation they lack authority to continue the exception process after July 1, 2019.  At our and WHCA’s urging, the department agreed to move for emergency rule making to extend the exception process and introduce legislation in 2020 to clarify that they have the required statutory authority to do so.  Additionally, WHCA and LeadingAge appear to have successfully defeated the department’s plan to require a 90 day break between exceptions after July 1, 2019.  We argued that given that all parties have agreed that the nursing shortage requires the continuation of the exception process, it makes little sense that we would then expose the nursing facilities to citations and penalties for reasons that are beyond their control.  

As it stands currently, a nursing facility with 60+ beds can request a waiver to the 24/7 RN mandate if they can demonstrate a good faith effort to hire a registered nurse for the last eight hours of required coverage per day. In granting an exception, the department may consider wages and benefits offered by other skilled nursing facilities and the availability of registered nurses in the particular geographic area. The exception can be renewed yearly up to three consecutive years. The department and stakeholders will discuss the continuing need for the exception process to continue every three years beginning again by June 30, 2022. As a reminder, the department may limit the admission of new residents, based on medical conditions or complexities, when a registered nurse is not on-site and readily available.