"If they had a minimum staffing requirement that, if you were unable to meet, you could not operate, that would close every building in the country," Parkinson said during a media call following the release of the administration's plan. MECHANICSBURG, Pa. (March 1, 2023) LeadingAge PA, an association representing more than 370 aging services providers, including many who operate NurseDash offers a variety of features to help nursing homes with their staffing needs, including: If youre looking for a nursing staffing solution, look no further than NurseDash. "We think it's really important to set a very specific standard that can be measured against, to really make sure staff is adequate to ensure quality," says Chiquita Brooks-LaSure, administrator for the Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates and funds most nursing homes in the U.S. 0000031792 00000 n Eric Lee for NPR The Biden administration is planning to establish a federal minimum staffing requirement for nursing homes as part of a broader push to improve care for seniors and people with disabilities. Four of these states (AK, DE, IN, and WI) lowered the training hour requirements for CNAs during the pandemic, in efforts to address staffing issues. Over the next year, policy action is expected on the federal level related to nursing home staffing. Specifically, that report notes the need to improve worker wages, benefits, training, and working conditions as an integral part of improving nursing home resident health and quality of life. In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. could also make it difficult for facilities to find and retain high-quality nursing staff, which would reduce the number of residents that facility could support. And not one that runs smoothly. A December 2021 study reviewed state nursing home staffing standards and concluded that staffing standards in almost every state remain severely low. The Medicaid and CHIP Payment and Access Commission (MACPAC) recently reviewed state policies that can help address staffing issues, including increasing Medicaid payment rates, changing Medicaid payment methods to incentivize facilities to devote more revenue to staff, and requiring minimum staffing levels above the federal standard. The Biden administration is planning to establish a federal minimum staffing requirement for nursing homes as part of a broader push to improve care for seniors and people with disabilities. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. One of these states, Wisconsin, lowered the training hour requirement for nurse aides from 120 hours to the federal minimum of 75 hours. Learn about the latest news, announcements and upcoming events on the topics that are important to you and your business. On some days, she has as many as 13 residents to care for on a shift. Eric Lee for NPR She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. They're physically exhausted, and even committed people in this industry will turn around and say, 'I don't know how much longer I can do this,'" says Sandri. The federal government does already have some staffing requirements in place for example, each facility must have a registered nurse on duty for eight hours per day but the core language is vague. These changes apply to all staff and are not limited to providers that participate in Medicaid. This equates to 0.30 staffing hours per resident day (hprd).3 Facilities also must designate a full-time registered nurse as a full-time director of nursing. Are there federal nursing home staffing standards currently in place? 2.5 hprd for intermediate care, 3.8 hprd for skilled nursing care. Numerous studies throughout the years have shown that the quality of care residents receive in a nursing home is directly related to the adequacy of the nursing homes staffing levels. 0000007726 00000 n To attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. Michigan enacted a temporary one year increase of $2.35 per hour for direct care staff, including nurses and aides. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. Before sharing sensitive information, make sure youre on a federal government site. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. New York State Health Facilities Association. While staffing shortages in nursing homes have existed for decades, the COVID-19 pandemic has highlighted and intensified the need for sufficient, consistent, trained staff to care for residents. The pandemic has taken a substantial toll on people living and working in nursing homes. hide caption. The Department of Social Services has made funding available to nursing homes to meet the staffing requirements. President Bidens proposed Build Back Better bill, for example, would require the U.S. Department of Health and Human Services (HHS) to submit reports to Congress on the appropriateness of minimum staff to resident ratios in skilled nursing facilities,[4] signaling future potential minimum staffing ratios that might extend beyond the reach of COVID-19. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. North Carolinas legislature appropriated $1 million for one-time bonus payments to direct care staff, while Ohios legislature appropriated $300 million for wages, incentives, and bonuses to recruit and retain direct care staff. Insufficient nursing home staffing levels are associated with negative outcomes for residents including increased rates of hospitalization, dehydration, weight loss, and pressure ulcers. Flexible pay and scheduling structures for nursing staff, including incentive pay, career development and training programs, and alternative benefits that do not increase base pay. 0000004038 00000 n Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. State Actions to Address Nursing Home Staffing During COVID-19, most likely to report a shortage of aides, staffing standards in almost every state remain severely low, must designate a full-time registered nurse as a full-time director of nursing, sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum, require a minimum number of staff hours per resident day, he primary reason that nursing homes declined to accept new residents, experiencing similar difficulty discharging patients to nursing homes due to staffing shortages, unpopular among nursing home industry representatives. At least three states (MI, NC, OH) adopted temporary increases or one-time bonuses to nursing home staff wages post-COVID. However, CMS recently announced that this waiver will sunset on June 6, 2022, citing concerns about care quality. Get the latest information, guidance, clarification, instructions, and recent COVID-related policies, Find the latest resources and guidance for people in nursing home and their caregivers, See more on the Providers & CMS Partners page, See more on the Patients & Caregivers page. The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that reflects resident census, acuity, case mix and residents professional nursing needs as determined by their assessments and care plans. A new law in New York state will require nursing homes to meet minimum standards for staffing and patient care. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Numerous studies have shown that understaffing nursing homes can harm the health of residents, who suffer more bedsores, more weight loss, more overprescribing of anti-psychotic medications, and during the pandemic more COVID-19 cases and deaths. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. 0000006058 00000 n In a statement provided to Skilled Nursing News, the state Department of Health said, at this time, nursing homes should appropriately document their efforts to comply with the law. Four out of 5 who initially express interest in a job don't come in for interviews. Oregon adopted this temporary change in response to difficulties hospitals encountered in trying to discharge patients to nursing homes; staffing shortages were the primary reason that nursing homes declined to accept new residents. For example, the U.S. Department of Justice and the Federal Trade Commission have recently increased enforcement against staffing agencies that price-fix nursing wages, as well as against nursing personnel agencies who engage in price gouging or unfair competition. Author(s) While federal requirements state that facilities must maintain sufficient nursing staff to meet residents needs, specific guidelines are not set and state regulations vary drastically. Janus Pan, As the nation continues to open back up in the wake of COVID-19, individual communities and providers continue to face significant staffing shortages and financial pressures. In conducting the cost-benefit analysis required for any rulemaking, including the staffing requirement, CMS must evaluate any associated incremental costs that facilities would likely face. [1] Tim Regan, 81% of Assisted Living Providers Report Recent Staff Shortages, Senior Housing News (June 23, 2021), available at https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/. Despite these existing requirements, understaffing continues to be a concern. Of course, once CMS issues its proposal for minimum staffing requirements in Spring 2023, that proposal will go through the notice-and-comment rulemaking processproviding further opportunities for all interested parties to weigh in. [8], States have also recently increased scrutiny over minimum nurse staffing levels. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. hide caption. Additionally, the federal regulations include a qualitative standard, which requires nursing homes to provide sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident. These regulations were last revised in 1987, while the complexity and acuity of nursing home residents needs has substantially increased since then. The Centers for Medicare and Medicaid Services (CMS) announced in November 2021 increased oversight of nursing services pursuant to 42 CFR 483.35, which mandates sufficient nursing staff at facilities receiving Medicare reimbursement: The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facilitys resident population in accordance with the facility assessment required at 483.70(e).[5], Specifically, CMS will survey nursing homes in the future for nurse competency, inappropriate use of antipsychotic medications, and other areas of residents health and concern. The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet In 29 states, including Maryland, the minimum staffing requirement is 3.5 hours or less, according to an analysis by the Consumer Voice. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining CMS also plans to conduct a research study, noting that resident acuity has increased in recent years, and to issue proposed regulations within one year. That is the main factor they stress at the job, yet you don't give us the staff to provide that," Ward says. CMS is also conducting a stakeholder listening session on August 29, 2022 from 1-2:30 p.m. EST to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. The Department recently made major changes to the state nursing home regulations. At least two states (OR, SC) adopted temporary decreases to account for potential staffing issues during the pandemic. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. Compared to the federal minimum of 0.30 hprd, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. We received many comments on the RFI from members of the public identifying themselves as family members or caretakers of residents living in nursing homes. [2] State of the Long Term Care Industry: Survey of nursing home and assisted living providers show industry facing significant workforce crisis, American Health Care Association, National Center for Assisted Living (September 2021), available at https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf. In Takoma Park, Maurice Miller doesn't blame the staff who have left his facility in recent weeks for other jobs. 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