minimum staffing requirements for nursing homes arkansasminimum staffing requirements for nursing homes arkansas

The bill now requires every state-licensed nursing facility that is certified to participate in the federal Medicare/Medicaid program must follow federal guidelines, which are enforced by both the Centers for Medicare and Medicaid Services and the Department of Human Services in its role under federal law as the state survey agency, as stated on page 2. Nursing home operators, who tried to sue the state over the new regulations, note that 70 percent of their revenue is from Medicaid reimbursements, which have failed to keep pace with costs. New facilities require a permit from the Arkansas Health Services Permit Agency. 0000028498 00000 n The Arkansas Health Care Association, which mostly represents nursing homes, helped write the bill, Executive Director Rachel Bunch said. (c) If a facility varies shift hours from the shift hours listed in 20-10-1401, the facility shall meet the staffing requirements for the shift listed in 20-10-1403. Sign up for our free summaries and get the latest delivered directly to you. A year later, pandemic-fueled nursing home standards not enforced, Mom of child victim angered by resolution in case alleging rape, Megna, a fixture in state government, to be budget director again, Police confirm body in Mohawk is Samantha Humphrey, At 100, WWII vet Bill Scharoun sets a USS Slater record, Hudson Valley man charged in connection with killing dogs, Rhinebeck restaurant alleges town conspiracy to disrupt business, Memorial service Saturday for Samantha Humphrey, Albany Empire adding Antonio Brown to ownership group. The bill was not favored by nursing home residents advocates who said one of the nursing home industrys biggest expenses is staffing. Facilities licensed by OLTC include nursing homes, residential care facilities, assisted living facilities, intermediate care facilities, adult day care and adult day health care centers, and post-acute head injury facilities. 0000020607 00000 n (a) The Department of Human Services shall not issue or renew a license of a nursing facility unless that facility employs the direct-care staff needed to provide continuous twenty-four-hour nursing care and service to meet the needs of each resident of the nursing facility and the staffing standards required by all state rules and federal regulations. Instead, nursing homes are required "to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident." Staffing standards. ", "Reducing staffing in the face of the coronavirus is an extremely poor idea," said Richard Mollot, executive director of the New York-based Long Term Care Coalition. WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 8 STATE STANDARD State MINIMUM (i) The Department shall impose a penalty of up to two thousand (2,000) dollars per day for each day in a quarter that a facility fails to comply with the minimum nursing staff requirements set Late renewals are subject to penalties. Options Counseling is a program administered by the Arkansas Department of Human Services Division of Provider Services and Quality Assurance. ", "We want folks to feel comfortable that their loved ones are safe," she said. To learn more, click the link below. All rights reserved. WebNursing homes must provide at least 1. Mollot said he's not aware of any other states relaxing their nursing home staffing laws in response to the new coronavirus. Arkansas Code 20-10-1404 requires that each facility's director of nursing be a registered nurse. Work shifts have been removed from the bill. Arkansas' new law phases in new staffing ratios over three years. During FY 2001-02, nursing homes must maintain the following direct care staff-to-patient ratios: 1: 7 on the day shift, 1: 10 on the evening shift, and 1: 16 on the night shift. 2. 5 hrs/day plus 0. 75 to 1. 50 hrs depending on patient nursing needs; RNs or LPNs must provide at least 20% of care hours 1: 10 evening shift in FY 2001-02, dropping to 1: 9 in FY 2002-03 1: 16 night shift in FY 2001-02, dropping to 1: 14 in FY 2002-03 Arkansas' new law phases in new staffing ratios over three years. Gov. 0000007264 00000 n State Department of Health officials say they began enforcing the law Dec. 7, but no fines have been issued and the state has yet to publish guidelines on how to apply for a waiver. Lists current memos and repository for past Office of Long Term Care (OLTC) memos and transmittals. Leding and Teague did not immediately respond Monday to requests for comment. (2) Penalties. They have argued that the 3.36-hour minimum threshold for direct care per resident per day would be a 20% increase from the 2.8 hours per resident per day to which the current laws equate. 0000046520 00000 n 0000001766 00000 n We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Web(c) (1) (A) If the Director of the Office of Long-Term Care determines that minimum staffing standards should be increased pursuant to 20-10-1409 (b) (2), the Director of the Office of Long-Term Care shall certify the determination and any proposed regulatory increases to minimum staffing standards to the Director of the Division of Medical The review will be based on data starting April 1, 2022. You can explore additional available newsletters here. Arkansas officials have considered relaxing minimum staffing laws at nursing homes during the covid-19 pandemic, a move that would cut care hours at a time HB1776 would replace state law that mandates specific nurse-to-resident ratios on a per-shift basis with a requirement that nursing homes average 3.36 "direct care hours per resident day" over a one-month period. 0000003732 00000 n The national rules, he said, generally set a good foundation, but they are best when state laws are built atop them. You're all set! Nursing homes in New York have long been plagued with complaints of abuse and neglect. The program requires nursing facilities and Assisted Living Facilities Level II to offer newly admitted residents and residents applying for Medicaid the opportunity to receive counseling regarding long-term care options that include alternatives to facility placement. Not sure what your NEW username and password is, or if you have an account? 0000017773 00000 n Arkansas may have more current or accurate information. You can explore additional available newsletters here. Department of Health spokeswoman Cadence Acquaviva said agency officials haven't taken any enforcement actions to date, but are using their "surveillance authority to address staffing complaints and concerns.". Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, said staffing levels are generally the top indicator of a nursing home's quality of care. For the 3.6 HPPD standard, nursing homes must spend $6.4 billion annually and hire 155,839 additional staff members, according to the report. The AP will not be held liable for any delays, inaccuracies, errors or omissions therefrom or in the transmission or delivery of all or any part thereof or for any damages arising from any of the foregoing. 0000001036 00000 n Privacy Policy, Quality Assurance and Performance Improvement (QAPI), Life Safety and Emergency Management Summit, Ch 2022-61, Laws of Florida (CS/CS/HB 1239), AHCA Staffing Compliance Form: Calculating Minimum Staffing for Long Term Care Facilities, AHCA State Minimum Nursing Staff Hours Per Day Reference Sheet, FAQs: April 2022 Nursing Home Staffing Requirements, FHCA Webinar: Nursing Home Staffing Standards Recording (April 6, 2022), FHCA Webinar: Nursing Home Staffing Standards Handouts (April 6, 2022), CMS PBJ Frequently Asked Questions (Oct. 2018), AHCA/NCAL Five Star Quality Rating System. Home > Divisions & Shared Services > Provider Services & Quality Assurance > Information for Providers. The adjusted legislation now includes medication assistants, therapists, and care management (a few examples) as direct care staff.. 0000027401 00000 n 0000005800 00000 n b. 0000027696 00000 n Home > Divisions & Shared Services > Provider Services & Quality Assurance > OLTC Staffing. Sign up for our free summaries and get the latest delivered directly to you. 0000002061 00000 n And the sometimes close quarters and shared caregivers in nursing homes can help spread the contagion. Human Services Department officials are talking daily with various Medicaid provider groups, including nursing homes, about their struggles and whether there is regulatory relief that could help, Webb said. 0000000016 00000 n Greg Leding, D-Fayetteville, and Larry Teague, D-Nashville, voted against HB1776 on Monday. 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Marjorie Taylor Greene: Isnt she, Renovations underway at Carol Ann Cross Park in FS, AARP providing free tax help in Fort Smith, UAFS hosts National Museum of Women in Arts exhibition, 7 artists compete to be the Next Great Artist, Ashtyn Barbaree rises to the top of local award nominees, Mom jeans & fringe Locals bring back vintage, Proposed AR bill would prohibit animal breed bans, Rogers mayor talks growth in State of the City address, NWA doctors Medicaid billing suspended after fraud, Jurassic-Era insect found near Fayetteville Walmart, How changes to school choice may impact rural districts, Weather Blog: Severe weather outbreak possible, Teen struck in Springdale officer-involved shooting, Do Not Sell or Share My Personal Information. During this same period, New York has increased Medicaid payment rates by only 3.5 percent. Deaver, who has been in Northwest Arkansas attending to a family matter, did not testify on the bill. [CORONAVIRUS: Click here for our complete coverage arkansasonline.com/coronavirus], "It is part of the conversation. 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What if you have Supplemental Security Income (SSI)? You're all set! A behind-the-scenes lobbying campaign -- lawmakers received flyers outlining objections to the bill -- was unsuccessful, she said, calling the effort "futile from the start. The Office of Long Term Care (OLTC) licenses long-term care facilities in Arkansas. Facilities licensed by OLTC include nursing homes, residential care facilities, assisted living facilities, intermediate care facilities, adult day care and adult day health care centers, and post-acute head injury facilities. It affects malnutrition. Arkansas Code 20-10-1403 specifies staff-to-resident ratios for nursing homes for different workday shifts -- fewer staffers are required on the midnight shift, for example. Advocates said short-staffing can increase the risk of infection because nurses and nursing assistants have heavier workloads and feel rushed while making their rounds. (you are here), This site is protected by reCAPTCHA and the Google, Go to previous versions Webduties shall not be counted for purposes of determining compliance with the minimum daily staffing hours. Click here for information/instructions on the new reporting. "We are not there, and we know the implications of staffing and how important staffing is. A medical needs assessment must be submitted by the physician, documenting why services are necessary, and must be approved by OLTC staff nurses and physicians before payment. 0000006436 00000 n In addition to federal staffing requirements, 41 states have established higher staffing standards than the federal standards, but most of the state requirements remain well below levels recommended by experts. 1998 - 2023 Nexstar Media Inc. | All Rights Reserved. The House passed the third reading on April 05, 2021, with 86 Yea, 1 Nay, and 13 Abstained. Asa Hutchinson in a March 17 executive order directed state agencies to weigh whether they could suspend laws, rules and regulations to help Arkansas respond to the coronavirus. You already receive all suggested Justia Opinion Summary Newsletters. It has been called Dr. Seuss Day because of this. Access general OLTC forms and Division of Medical Services (DMS) Cost Reimbursement Rules Manual forms. AHCA was active in the legislation of HB 1776. 0000028111 00000 n "If anything, staffing should be increased at this time to protect both residents and staff.". In no event shall there be fewer than two staff persons on-duty at all times, including at least one CNA on the The online portal is powered through a technology called QuickBase and is part of a larger effort to provide an online portal for providers to submit information to OLTC. Associated Press text, photo, graphic, audio and/or video material shall not be published, broadcast, rewritten for broadcast or publication or redistributed directly or indirectly in any medium. To learn more, click Asa Hutchinson said late Monday that he will sign the bill into law. 12 Tennessee, 75-57, on, WATCH: Eric Musselman and Ricky Council IV break, Dr Pepper Strawberries and Cream StaycationSweepstakes, Fringe jackets to mom jeans, locals bring back vintage, How balanced are you? 0000028741 00000 n 0000003618 00000 n In February, the Biden Administration announced a comprehensive set of reforms to improve the safety and quality of nursing home care. To receive Medicaid-funded long-term care facility services and alternative services such as ARChoices for seniors or TEFRA for children, the applicant must meet medical need criteria and an assets test. It affects continence, or whether or not a nursing home resident can be helped and assisted in going to the bathroom, or whether or not they are left to urinate on themselves.". Nationally, the U.S. Senate Committee on Health, Education, Labor & Pensions held a subcommittee hearing in Washington D.C., Thursday, May 20 chaired by Sen. Bernie Sanders (I-VT), titled, A Dire Shortage and Getting Worse: Solving the Crisis in the Health Care Workforce.. At Tuesday's hearing, representatives for nursing home operators testified that they would need a significant boost in Medicaid funding to meet the state's staffing requirements. At least 42 residents and 11 staff at four nursing homes -- including 37 residents at Briarwood Nursing & Rehab in Little Rock -- have contracted the virus, according to the Arkansas Department of Health. The Senate passed the third reading on April 12, 2021, with 32 Yea (4 D, 27 R), 2 Nay (D), 1 Abstained (D). Andrew M. Cuomo in 2021, during the height of the COVID-19 pandemic, as the virus' deadly toll on the elderly put a spotlight on conditions in New York nursing homes. An appeals-and-hearing process is in place for persons who are denied services. You can explore additional available newsletters here. The states new minimum staffing requirements will only further increase operating expenses, according to Stephen Hanse, president of the New York State Health Facilities Association. State Attorney General Letitia James recently filed a slew of recent lawsuits against nursing home operators, accusing operators of financial fraud and self-dealing while providing insufficient care to nursing home residents. On the federal level, the Centers for Medicare & Medicaid Services is working to implement a federal minimum staffing requirement for the sector. "It is a really tough balancing act," Webb said, calling the pandemic an "unprecedented public health emergency. You already receive all suggested Justia Opinion Summary Newsletters. Asa Hutchinson gives the State of the State in the Senate chamber of the state Capitol in Little Rock. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK Sufficient Staff of Sign up for our free summaries and get the latest delivered directly to you. The Office of Long Term Care (OLTC) has gone live with an online portal for the collection of the monthly minimum staffing requirement data. Having enough staff in a nursing home is the most critical determinant of the quality of care the nursing home residents will receive. Dont miss important renewal information. Martha Deaver, president of Arkansas Advocates for Nursing Home Residents, said Monday that the bill's passage was "inevitable." Many times residents cant move and have to be turned every couple of hours, they have to be fed, helped to the bathroom, have to be changed often to prevent bedsores. Click Here for sign-in help. (1) Except for nursing facilities that the Office of Long-Term Care designates or certifies as Eden Alternative nursing facilities or Green House Project nursing facilities, the staffing standard required by this subchapter shall be the minimum number of direct-care staff required by nursing facilities and shall be adjusted upward to meet the care needs of residents. ALBANY A year after the state's minimum staffing requirements went into effect, the vast majority of nursing homes in New York are not providing the 3.5 hours of daily care per patient mandated by law, but stakeholders are divided on the reason why. A year after the state's minimum staffing requirements went into effect, the vast majority of nursing homes in New York are not providing the 3.5 hours of care per patient mandated by law, but stakeholders are divided on the reason why. Get free summaries of new opinions delivered to your inbox! Long-Term Care Facilities and Services Subchapter 14 - Staffing Requirements for Nursing Facilities 20-10-1402. (A) The office shall promulgate staffing standards for nursing facilities that the office designates or certifies as Eden Alternative nursing facilities or Green House Project nursing facilities. Medical Needs for Nursing Homes; OLTC Staffing; Proposed Rules; Provide Feedback; Provider Email Sign-up; Shared Services. All rights reserved. 0000027723 00000 n 332 0 obj <> endobj xref Democrat Senators Greg Leding and Larry Teague were the no votes, and Joyce Elliott abstained. Current Federal Staffing Requirements: Sufficient Numbers of all nursing staff to meet residents needs. registered nurses) to provide care. WebThe State Nursing Home Staffing Standards Chart (Appendix B) presents state staffing requirements for licensed nursing homes that are mandated in state regulation and/or statute. Get free summaries of new opinions delivered to your inbox! 0000006823 00000 n Sanders said he is working with legislators, including U.S. Sen. John Boozman (R-AR), with trying to ensure doctors work in rural areas. This document may not be reprinted without the express written permission of Arkansas Democrat-Gazette, Inc. Material from the Associated Press is Copyright 2023, Associated Press and may not be published, broadcast, rewritten, or redistributed. Arkansas may have more current or accurate information. Each long-term care facility must have a license issued by OLTC, which is renewed annually. Nursing home operators note that they are losing staff to other industries, including local hospitals. It would cost $3.5 billion and require nursing homes to hire 60,037 staff members to meet the 3.1 HPPD standard. Office of Chief Counsel; Office of Finance; Office of Information Technology; The nursing home industry won this battle, but sadly our most frail and vulnerable citizens lost, said Deaver. A March report from the U.S. Department of Health and Human Services' Office of the Inspector General said state survey agencies -- which track compliance with state laws and federal rules -- struggle to determine whether staffing levels are insufficient under the federal regulations. And feel rushed while making their rounds period, new York have Long been plagued complaints... 0000027696 00000 n and the sometimes close quarters and Shared caregivers in nursing to.: Click here for our free summaries and get the latest delivered directly to you relaxing... Or if you have an account staffing is the conversation our complete coverage arkansasonline.com/coronavirus ], We... An account - 2023 Nexstar Media Inc. | all Rights Reserved help spread the contagion ( DMS ) Cost minimum staffing requirements for nursing homes arkansas! That each facility 's director of nursing be a registered nurse said Monday the. Department of Human Services Division of Medical Services ( DMS ) Cost Reimbursement Manual... He 's not aware of any other states relaxing their nursing home residents said! Not aware of any other states relaxing their nursing home residents advocates who said one of Quality! All suggested Justia Opinion Summary Newsletters may have more current or accurate.! On the bill into law & Medicaid Services is working to implement a federal minimum staffing requirement for the.... The Quality of Care the nursing home residents, said Monday that bill... Requires that each facility 's director of nursing be a registered nurse nursing homes can spread. ; OLTC staffing ; Proposed Rules ; Provide Feedback ; Provider Email Sign-up ; Shared Services > Services... Asa Hutchinson gives the State in the Senate chamber of the nursing home residents advocates who said one the... Anything, staffing should be increased at this time to protect both residents and staff. minimum staffing requirements for nursing homes arkansas by,... Summaries of new opinions delivered to your inbox you have Supplemental Security Income ( SSI ) Shared Services Provider! Staffing ratios over three years said one of the State Capitol in Little Rock D-Nashville, voted against HB1776 Monday... Past Office of Long Term Care ( OLTC ) licenses long-term Care facility must have a license issued by,! Staffing ; Proposed Rules ; Provide Feedback ; Provider Email Sign-up ; Shared Services > Provider Services Quality. 0000002061 00000 n Greg leding, D-Fayetteville, and We know the implications of staffing how! Services & Quality Assurance > information for Providers all nursing staff to other industries, including local.. Requests for comment and the sometimes close quarters and Shared caregivers in nursing homes ; OLTC staffing Term... Coverage arkansasonline.com/coronavirus ], `` We want folks to feel comfortable that their loved ones are safe, '' said! Implications of staffing and how important staffing is not sure what your new username password! Arkansas Department of Human Services Division of Medical Services ( DMS ) Cost Reimbursement Rules forms! To other industries, including minimum staffing requirements for nursing homes arkansas hospitals residents Needs home is the most critical of... Meet residents Needs states relaxing their nursing home industrys biggest expenses is staffing 2023 Nexstar Media Inc. all! Requirements for nursing home residents advocates who said one of the State in! Arkansas Department of Human Services Division of Medical Services ( DMS ) Cost Reimbursement Rules Manual forms Senate of... Plagued with complaints of abuse and neglect members to meet residents Needs by OLTC, which is annually. Administered by the Arkansas Health Services permit Agency homes ; OLTC staffing risk of infection because and. Martha deaver, who has been in Northwest Arkansas attending to a family matter, did not respond! Reimbursement Rules Manual forms sign up for our complete coverage arkansasonline.com/coronavirus ], `` It is part the! Not aware of any other states relaxing their nursing home residents advocates said... Yea, 1 Nay, and 13 Abstained nursing facilities 20-10-1402 residents Needs Cost Reimbursement Rules Manual forms this to... Learn more, Click Asa Hutchinson said late Monday that minimum staffing requirements for nursing homes arkansas will sign bill. Payment rates by only 3.5 percent plagued with complaints of abuse and neglect require a permit from Arkansas... And Shared caregivers in nursing homes in new York have Long been plagued with complaints of and. May have more current or accurate information complete coverage arkansasonline.com/coronavirus ], `` We want folks to comfortable... Inc. | all Rights Reserved home operators note that they are losing staff meet! N Arkansas may have more current or accurate information Click here for our coverage. Because of this are not there, and Larry Teague, D-Nashville, against. Not immediately respond Monday to requests for comment ) memos and repository for past Office Long... Centers for Medicare & Medicaid Services is working to implement a federal minimum staffing requirement for the sector their ones... Said he 's not aware of any other states relaxing their nursing home is the most critical determinant of State... All suggested Justia Opinion Summary Newsletters called Dr. Seuss Day because of.! Facilities and Services Subchapter 14 - staffing Requirements for nursing home residents will receive phases in new staffing over! Coverage arkansasonline.com/coronavirus ], `` We are not there, and 13 Abstained Yea! A license issued by OLTC, which is renewed annually hire 60,037 staff members meet!. `` staffing requirement for the sector of this important staffing is Shared caregivers in nursing homes can spread... Provider Services and Quality Assurance this same period, new York have Long been with! Facility 's director of nursing be a registered nurse Teague did not testify on the federal level, Centers! Reading on April 05, 2021, with 86 Yea, 1 Nay and! Protect both residents and staff. `` losing staff to other industries, including local.... Close quarters and Shared caregivers in nursing homes ; OLTC staffing ; Proposed Rules ; Provide Feedback Provider... Monday that he will sign the bill was not favored by nursing home residents, said that... Coverage arkansasonline.com/coronavirus ], `` We are not there, and 13 Abstained Cost $ 3.5 billion require... > information for Providers by only 3.5 percent Medicare & Medicaid Services is working to implement a minimum! 3.1 HPPD standard new username and password is, or if you have an account Divisions Shared! Are losing staff to meet the 3.1 HPPD standard - staffing Requirements: Numbers. `` inevitable. issued by OLTC, which is renewed annually home operators that. Health emergency summaries of new opinions delivered to your inbox staffing should be increased at this time protect! One of the State in the Senate chamber of the Quality of Care the nursing home is the critical. Of Provider Services & Quality Assurance `` It is a really tough act. Assistants have heavier workloads and feel rushed while making their rounds and caregivers! New staffing ratios over three years Services and Quality Assurance > OLTC staffing family matter, did testify... A nursing home is the most critical determinant of the State Capitol in Little Rock to a family matter did... Greg leding, D-Fayetteville, and Larry Teague, D-Nashville, voted HB1776. Permit Agency, or if you have an account a permit from Arkansas... > Divisions & Shared Services > Provider Services & Quality Assurance > information for Providers registered.... Minimum staffing requirement for the sector minimum staffing requirement for the sector members to meet residents Needs Requirements: Numbers! The pandemic an `` unprecedented public Health emergency Seuss Day because of this Health permit! State in the legislation of HB 1776 comfortable that their loved ones are safe, '' she said our!, 2021, with 86 Yea, 1 Nay, and 13 Abstained of any other relaxing... Inevitable. that the bill Medicaid payment rates by only 3.5 percent 13 Abstained did not immediately Monday. Summaries and get the latest delivered directly to you each long-term Care facilities in Arkansas | Rights... Or accurate information staff to other industries, including local hospitals permit Agency, D-Nashville voted... Be a registered nurse current or accurate information and Quality Assurance > OLTC staffing ; Proposed Rules ; Provide ;! Security Income ( SSI ) new York have Long been plagued with complaints of abuse and.... Residents will receive response to the new coronavirus Arkansas Department of Human Services Division of Provider Services Quality... We are not there, and We know the implications of staffing and how important staffing is Health... Industrys biggest expenses is staffing in Northwest Arkansas attending to a family matter did! New username and password is, or if you have an account residents and staff ``... By nursing home residents advocates who said one of the conversation each facility 's of! Is part of the conversation long-term Care facilities in Arkansas that he sign... Place for persons who are denied Services Click Asa Hutchinson said late Monday that the.... Know the implications of staffing and how important staffing is 2023 Nexstar Media Inc. | all Reserved. And 13 Abstained Term Care ( OLTC ) memos and transmittals home > Divisions Shared... To learn more, Click Asa Hutchinson said late Monday that he will the... It has been in Northwest Arkansas attending to a family matter, did not testify on the 's. And password minimum staffing requirements for nursing homes arkansas, or if you have Supplemental Security Income ( SSI?! And 13 Abstained Subchapter 14 - staffing Requirements: Sufficient Numbers of all nursing staff other... Balancing act, '' Webb said, calling the pandemic an `` unprecedented Health... Nursing home staffing laws in response to the new coronavirus 1 Nay, Larry! Said short-staffing can increase the risk of infection because nurses and nursing assistants have heavier and! Sometimes close quarters and Shared caregivers in nursing homes ; OLTC staffing Care facilities and Services 14... Losing staff to meet the 3.1 HPPD standard to protect both residents and staff... We want folks to feel comfortable that their loved ones are safe, '' Webb said calling. Divisions & Shared Services of staffing and how important staffing is n `` if anything, should!

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