Legislation intended to address the nursing shortage and nursing home staffing was proposed in the first session of the 107th Congress, but nurses and consumers shouldn't get their hopes up for quick relief.

With Congress now in its second session, it is clear that the events of Sept. 11 have reordered everyone's priorities. Nonetheless, domestic issues that dominated the legislative schedule in the first session will eventually re-emerge. Among them, health care workforce issues and quality of care in long-term care facilities.

The announcement Sept. 28 by Health and Human Services Secretary Tommy Thompson that he intends to release $27.4 million for nursing education and loan repayment contracts is a sign that the process already is under way.

The scale of the terrorist attacks dramatized how critical the nursing shortage is to national security. The thousands of casualties created in a matter of minutes underscored the need to address the nursing shortage sooner rather than later.

As a result, despite pessimistic comments by some members of Congress in late September about the chances of seeing action on any of the proposed bills dealing with the nursing shortage in the second session, at least one such bill now has moved from the back burner to the front.

Rep. William Tauzin, R-La., announced Oct. 3 that HR 1436, the Nurse Reinvestment Act, sponsored by Rep. Lois Capps, D-Calif., has been given higher priority for action by his committee. Tauzin is the chair of the House Committee on Energy and Commerce.

HR 1436 would establish nursing recruitment grants, fund public service announcements to promote careers in nursing, set up a career ladder grant program, fund grants for health career education partnerships and establish a national nurse service corps. It also would expand spending of Medicare and Medicaid funds for nursing education.

In all, the bill would allocate $348 million for nursing recruitment and education from 2002 to 2004. Tauzin has not indicated when the bill might be reported out of committee.

During the first session, legislation to address short staffing in long-term care facilities was proposed in the House. Two bills in particular are worth a closer look: one by Rep. Henry Waxman, D-Calif., and the other by Rep. Paul Ryan, R-Wis.

Waxman introduced HR 2677, the Nursing Home Quality Protection Act, which would reinstate the nursing home reimbursement method in use before the implementation of PPS, the prospective payment system created by the Balanced Budget Act of 1997.

The earlier reimbursement system required nursing homes to be paid based on their costs for providing care. That provision should win general support from the nursing home industry because it would increase payments to skilled nursing facilities beyond what they receive under PPS--at least according to many industry analysts. However, other provisions of the Waxman bill may not be as welcome.

The bill calls for nursing homes to meet the Hartford staffing standards within two years of enactment. The standards were developed by the John A. Hartford Foundation Institute for Geriatric Nursing and call for staff-to-resident ratios of 1-to-5 on day shift, 1-to-10 on afternoon shift and 1-to-15 on night shift.

Although the bill appears to require that the Hartford standards be implemented, it also provides for "case-mix adjustment" by HHS and for implementation of the standards to be delayed as long as the secretary determines that implementation is "not feasible."

The bill does not specify how the feasibility of the standards is to be determined. This feature means the bill may have little actual impact on nursing home staffing practices.

The Ryan bill, HR 1510, the Medicare and Medicaid Nursing Services Quality Improvement Act, is even less likely to have any positive effect on staffing woes in the nation's nursing homes.

Despite the grandiose title, the bill has nothing to do with nurse staffing or quality improvement. It merely creates a demonstration project in eight states to allow non-nursing personnel to assist nursing home residents at mealtimes.

The bill prohibits these "resident assistants" from performing any other non-nursing tasks that might free up nursing staff to perform more resident care. It does create more paperwork for the nursing homes and HHS, though.

The nursing home must report data on its workforce to the state and HHS must report on the results of the demonstration projects by no later than Dec. 1, 2004.