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Why hospitals are joining nursing homes in fighting minimum staffing rules


The federal government has finalized the first staffing standards for nursing homes. Long-term care facilities say the rule is unrealistic, and hospitals say it could limit post-acute care options.

After much anticipation, the federal government has finalized rules requiring minimum staffing levels at nursing homes, and long-term care facilities and hospitals are pushing back against the mandates.

The federal government has finalized the first staffing regulations for nursing homes, but long-term care facilities and hospitals are pushing back against the mandate.

The federal government has finalized the first staffing regulations for nursing homes, but long-term care facilities and hospitals are pushing back against the mandate.

For the first time, nursing homes are looking at staffing requirements set by the federal government. The Centers for Medicare & Medicaid Services announced this week that nursing homes would be required to provide residents about 3.5 hours of nursing care per day, with about a half-hour of care coming from a registered nurse and 2.45 hours of care per day from nurse aides.

In addition, nursing homes will be required to have a registered nurse onsite, 24 hours per day, seven days per week.

The healthcare industry has been waiting for the rule since the government first announced the proposal in September. Federal officials, including Vice President Kamala Harris, say the rule will offer more protection for the nearly 1.2 million residents in facilities receiving Medicare and Medicaid funding.

While some say the rule is designed to improve care and safety in nursing homes, long-term care facilities have assailed the government’s rule as unrealistic.

Hospitals have also spoken out against the rule, saying the staffing standards could cause more problems for hospital patients.

Not enough nurses

The American Hospital Association has argued that nursing homes could be forced to reduce the amount of residents they accept, and hospitals could find it harder to discharge patients to long-term care facilities. Hospitals are already seeing delays in discharges because they can’t find beds in post-acute facilities for patients who no longer require hospital care.

Stacey Hughes, executive vice president of the American Hospital Association, said in a statement, “CMS’ one-size-fits-all minimum staffing rule for nursing homes creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements.”

“This final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise high performers on quality and safety metrics,” Hughes said. “The loss of these nursing home beds could adversely impact patients who have completed their hospital treatment and need continuing care in nursing facilities.”

The Catholic Health Association said it fears the staffing requirement will force facilities to “leave beds empty or even close if there are not enough nurses to meet the mandate.”

“We are deeply disappointed that the final rule not only establishes an ill-advised staffing mandate, it increased the hours requirement,” the group said in a statement. “There simply are not enough qualified nurses to satisfy the standards. And if there were, inadequate Medicaid and Medicare reimbursement rates mean there are not the resources to pay them.”

The American Health Care Association, which represents nursing homes and long-term care facilities, said the rule will likely cause the closure of some facilities. Mark Parkinson, president and CEO of the AHCA, issued a stinging statement after the announcement.

“While it may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors' access to care,” Parkinson said in a statement.

Parkinson, the former governor of Kansas, said the rule doesn’t recognize the reality that there simply aren’t enough caregivers.

“Issuing a final rule that demands hundreds of thousands of additional caregivers when there's a nationwide shortfall of nurses just creates an impossible task for providers,” Parkinson said. “This unfunded mandate doesn't magically solve the nursing crisis.”

Emmett Reed, CEO of the Florida Health Care Association, which represents nursing homes in the Sunshine State, called the CMS rule an “unfunded and flawed mandate.”

“This impossible and unfunded mandate will make it harder to recruit long-term care workers and ensure Florida seniors have access to the specialized and person-centered services they need,” Reed said in a statement.

Some lawmakers are backing legislation to block the Biden administration’s staffing rule for nursing homes. In March, the House Ways & Means Committee passed a bill that would prevent the staffing requirement from taking effect.

‘Long overdue’

Nonetheless, President Biden and some members in Congress have been pushing for improvements in nursing home quality. The Biden administration has sought more transparency in nursing home ownership and management.

At a roundtable in Wisconsin Monday, the vice president touted the importance of the rule.

“For residents, this will mean more staff, which means fewer ER visits potentially, more independence for families. It’s going to mean peace of mind in terms of your loved one being taken care of,” Harris said.

In September, CMS announced a $75 million effort to boost staffing in nursing homes.

The high number of COVID-19 infections and deaths engendered criticism from lawmakers and advocates for seniors. About 170,000 nursing home resident deaths have been tied to COVID-19, according to CMS data.

The AARP has been pushing the federal government for minimum staffing standards in nursing homes and welcomed the CMS announcement.

“CMS’s long overdue rule to require minimum staffing levels in America’s nursing homes will help protect the basic rights of residents to live in dignity,” Nancy LeaMond, the AARP’s executive vice president and chief advocacy and engagement officer, said in a statement.

“It is shameful that nursing homes receiving taxpayer dollars through Medicaid and Medicare haven’t been required to provide quality care through specific minimum staffing standards until now,” LeaMond said. “Far too many residents and families have experienced tragic consequences because of poorly staffed facilities.”

U.S. Sen. Bob Casey Jr., D-Pa., who has pushed for better staffing and oversight of nursing homes, praised the staffing standards.

“Our nation’s 1.2 million nursing home residents expect and deserve high quality care that prioritizes health, safety, and human dignity,” Casey said in a statement. “But for too long, many nursing homes have not met this threshold due to understaffing and inadequate enforcement.”

U.S. Sen. Elizabeth Warren, D-Mass., said in a message posted on X, “Nursing home residents — our parents, family members, and friends — are too often stuck in facilities without enough staff to keep them healthy and safe. The Biden-Harris administration’s new minimum staffing rules will protect seniors and improve quality of care.”

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.”

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