Since 2022, when the Biden administration released their proposed nursing home reforms, staffing standards have been in the spotlight. Nursing homes have always suffered when it comes to staffing, making living conditions worse for residents, and working conditions worse for staff members in an already tough profession. As of September 1, 2023, Centers for Medicare & Medicaid Services submitted their proposed staffing standard rules. Here’s what you need to know.
The Staffing Issue
As reported in a previous blog, a 2001 study conducted by the Centers for Medicare and Medicaid Services (CMS) found that nursing home staff should be able to dedicate 4.1 hours per day to each resident. This equals about “one nurse for every seven residents on day and evening shifts.” This amount of care is the minimum to ensure proper hygiene, adequate supervision, and the prevention of bedsores and falls. However, as of a 2019 study, only a third of nursing homes meet that minimum.
Staffing Standard Rule Proposal
The official documents submitted by CMS states:
“This proposed rule would establish minimum staffing standards for long-term care facilities … This rule proposes to require States to report the percent of Medicaid payments for certain Medicaid-covered institutional services that are spent on compensation for direct care workers and support staff.”
Specifically, they outline the following rules:
- Nursing homes would be required to provide only 3 hours of direct care per resident per day. This requirement would include only .55 hours of Registered Nurse (RN) care and 2.45 hours of certified nurse aide (CNA) care. The NPRM failed to propose a minimum for licensed practical nurses (LPNs) who play a critical role in nursing home care.
- Facilities would be eligible for waivers from complying with this minimum if they met certain criteria.
- Implementation of the requirement would be phased in over a 3-year period.
- Facilities would be required to have an RN on staff 24 hours a day, 7 days a week. This requirement would be an increase from the current requirement of eight hours per day.
Unfortunately, these rules are still insufficient. As noted, “nursing homes would only be required to provide 3 hours of direct care per resident per day” when 4.1 is the absolute minimum for optimal care. Additionally, nursing homes can apply for waivers for meeting this minimum, eliminating any motivation to reach the higher, more necessary hourly number of 4.1. Finally, these rules would be implemented over 3 years, meaning there is an enormous amount of time before nursing homes are held accountable to this minimum.
The staffing issues run deep. There are lots of problems that lead to burnout and high staff turnover in the nursing home industry—from salaries, to understaffing, to other challenges. All of these things must be addressed to create a good working and living environment for everyone. While these rules are a step in the right direction, it is important that we keep advocating for the best care possible for our elderly citizens.
Share your opinions of these new rules via email at HealthandSafetyInquiries@cms.hhs.gov. And let your representatives know that we care about nursing homes changes and staffing standards that meet quality standards.
If you or a loved one have been the victim of nursing home abuse or neglect, call Gharibian Law (877-460-1187) for a FREE consultation and the best legal representation.
