Feds unveil new staffing requirements for nursing homes: Impact and reactions

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The government says the proposal will help residents and staff. Nursing homes and hospitals say the move could force some facilities to close.

For the first time, President Biden’s administration has unveiled a proposal on minimum staffing requirements for nursing homes, including staffing levels for nurses.

U.S. Health and Human Services Secretary Xavier Becerra says minimum staffing levels at nursing homes will help residents and staff. (Photo: HHS)

U.S. Health and Human Services Secretary Xavier Becerra says minimum staffing levels at nursing homes will help residents and staff. (Photo: HHS)

The Centers for Medicare and Medicaid Services introduced the proposal Friday. The Biden administration has said establishing standards on staffing is a key step to improve nursing home quality.

Trade groups representing nursing homes and hospitals are pushing back, saying the proposal could cause some facilities to close and reduce options for seniors.

U.S. Health and Human Services Secretary Xavier Becerra said establishing staffing levels will improve conditions for residents and staff.

“Establishing minimum staffing standards for nursing homes will improve resident safety and promote high-quality care so residents and their families can have peace of mind,” Becerra said in a statement. “When facilities are understaffed, residents suffer.”

The proposal calls for nursing home residents to receive a minimum of three hours of direct care each day. Under the CMS proposal, each resident would be required to receive about 30 minutes of care from a registered nurse each day, and about 2.5 hours of care from a nurse’s aide every day.

In addition, the CMS proposal would require all nursing homes to have a registered nurse on site 24 hours a day, seven days a week.

The impact

About three-quarters of America’s nursing homes would have to improve their staffing, according to the CMS estimates.

More than 1.2 million Americans live in nursing homes, and the Biden administration has previously said it wanted to see some minimum standards for nursing homes. The administration has also said that it wants to see tougher penalties for homes that are consistently falling short.

Becerra said that the minimum staffing levels could improve staff retention, as nurses may be more likely to stay on the job if they know they have sufficient help.

‘Unrealistic’ and ‘unfathomable’

Nursing homes have said they need more support from the federal government to recruit and retain staff.

Mark Parkinson, president of the American Health Care Association, which represents more than 14,000 nursing homes and long-term care facilities, said the administration’s plan is “unrealistic.” He said it would require facilities to hire added nurses when there’s not an adequate supply.

“It is unfathomable that the Biden Administration is proceeding with this federal staffing mandate proposal. Especially when just days ago, we learned that CMS’ own study found that there is no single staffing level that would guarantee quality care,” Parkinson said in a statement.

“At the very same time, nursing homes are facing the worst labor shortage in our sector’s history, and seniors’ access to care is under threat,” he added. “This unfunded mandate, which will cost billions of dollars each year, will worsen this growing crisis.”

The American Hospital Association also criticized the Biden administration’s proposal for staffing requirements.

Ashley Thompson, the AHA’s senior vice president of public policy analysis and development, said the proposal could force some nursing homes out of business or, at the very least, admit fewer residents. If that happens, hospitals would be required to hold patients for longer periods while they wait for available beds in post-acute facilities, she said.

“Fewer nursing home beds could adversely impact hospital patients who are denied the specialized care they are prescribed when they must stay, sometimes months, in hospital beds awaiting discharge to post-acute care settings,” Thompson said in a statement. “This could become especially dire in rural and underserved communities.”

Biden’s proposal also comes at a time when there’s a growing push for minimum nurse staffing ratios in hospitals.

Oregon has just enacted a new law establishing minimum staffing levels in hospitals. Other states are weighing similar proposals, and U.S. Sen. Sherrod Brown, D-Ohio, has introduced legislation to set nurse staffing levels nationwide.

Calls for change

The Biden administration and members of Congress have been pushing for improvements in nursing home quality.

Lawmakers criticized nursing home operators for the number of COVID-19 deaths in long-term care facilities. Nearly 168,000 nursing home resident deaths have been tied to COVID-19, according to CMS data.

The National Academies released a report in April 2022 calling for changes in the funding and operation of nursing homes. The report concluded “the way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable.”

‘An important step’

The AARP welcomed the federal government’s move to require minimum staffing standards in nursing homes. The AARP has long urging the government to do more to improve care for nursing home residents.

“COVID-19 revealed what AARP and other advocates have been saying for decades: the lack of standards and poor-quality care in too many of America’s nursing homes is deadly,” Nancy LeaMond, the AARP’s executive vice president and chief advocacy and engagement officer, said in a statement. “Far too many Americans died in those facilities, which have been plagued with problems for many years. Today’s proposal is an important step to establish a minimum nursing home staffing standard.”

The AARP singled out the inclusion of a requirement of a registered nurse being onsite at all times.


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