Senate Bill S-2878

Dear Senator:

I am writing to you regarding Senate Bill S-2878, Minimum CNA Staffing Requirements for Nursing Homes.  It has been brought to my attention that a proponent of this bill, the AARP, contends that a contributing factor of wound care and pressure sores in nursing homes is due to the lack of Certified Nurses Aides (CNA).

As the President of Wound Care Specialist of New Jersey, a company that specializes in the treatment and care of wounds for nursing home residents, I can assure you that the treatment of wounds is a complicated process involving several different healthcare professionals. The cause of wounds is a result of a resident’s medical condition, his/her multiple diagnoses or co-morbidities, and less likely the number of a particular kind of staff that may or may not be employed by a nursing home. There is no correlation between the number of staff and the number and frequency of wounds in a nursing home.

The treatment of wounds in the nursing home requires the services of a properly trained and experienced nursing professional, preferably a Register Nurse (RN), and a certified and experienced nutritionist,  both coordinating their efforts under the guidance of properly trained medical physicians. Wounds need to be treated, measured, and assessed properly in order to heal. The resident’s diet requires a proper assessment and monitoring to promote healing as well for wound prevention. The physician is required to assess the wound and prescribe the medications and treatment types to heal the wound and to protect it from infection. In some instances, complicated wound care equipment such as suction machines are used to promote faster healing of large more complexed wounds.

Naturally, the prevention of wounds is preferred over the treatment of wounds. Prevention is achieved through the medical assessment of the resident at the time of admission, and subsequent assessments of those residents determined to be at high risk for wound care or pressure sore issues. Again these assessments are completed by the healthcare professionals such as an RN, nutritionist and medical physician. By developing and implementing a resident’s unique wound care prevention care plan, the nursing home can prevent or delay the development of pressure sores. However, this care plan may not prevent pressure sores. There is no guarantee that a resident will not develop a pressure sore.

Therefore, simply stating that the prevalence of pressure sores in nursing homes is caused by a lack of a particular staff is not accurate and is unreliable. The AARP report also fails to reconcile the types of patients admitted to nursing homes. Does New Jersey admit a higher number of complicated high risk patients directly from the hospital than do other states? If so, then it is feasible that NJ nursing homes will have more residents who are at a higher risk to develop pressure sores and that some of those residents will develop pressure sores.

I do understand that CNAs contribute to the care of the residents in ways that are too numerous to list. However, if nursing homes are required to increase the CNA staff, they may be inclined to reduce the number of their professional staffs such as RNs, who are actually responsible for the assessment, prevention and treatment of residents with wound care and pressure sores.

Thank you,

Wound Care Specialist of New Jersey

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