HHS proposes minimum staffing standards for nursing homes
CMS estimates about 75% of nursing homes would have to strengthen staffing in their facilities under the proposal.
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The U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, has issued a proposed rule that seeks to establish comprehensive staffing requirements for nursing homes – including, for the first time, national minimum nurse staffing standards.
The action was prompted by President Biden's Action Plan for Nursing Home Reform, launched during the 2022 State of the Union.
Under the proposal, nursing homes participating in Medicare and Medicaid would be required to meet specific nurse staffing levels that promote safe, high-quality care for residents. Nursing homes would need to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day.
While the American Hospital Association said it supports having a skilled workforce in place, the AHA voiced concern about current delays in moving patients from the hospital to a nursing home due to capacity issues.
"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," said Ashley Thompson, senior vice president, Public Policy Analysis and Development for the AHA. "This could become especially dire in rural and underserved communities. The AHA has already documented rising lengths of stay for hospital patients in need of skilled post-acute care."
Also, Thompson said, implementing a numerical staffing threshold could drive nursing homes to further reduce capacity or close in order to meet the requirements.
WHAT'S THE IMPACT?
CMS estimates about 75% of nursing homes would have to strengthen staffing in their facilities.
In addition, nursing homes would also be required to ensure a registered nurse is on site 24/7, and to complete robust facility assessments on staffing needs. Facilities would continue to be required to provide staffing that meets the needs of the individual residents they serve, which may require higher levels of staffing above the proposed minimum standards.
CMS also proposes to require states to collect and report on compensation for workers as a percentage of Medicaid payments for those working in nursing homes and intermediate care facilities. These policies build on CMS' recent proposals to support compensation for direct care workers in home- and community-based settings and to publish Medicaid data on average hourly pay rates for home care workers.
Additionally, CMS announced a national campaign to support staffing in nursing homes. As part of the HHS Workforce Initiative, CMS will work with the Health Resources and Services Administration (HRSA) and other partners to make it easier for individuals to enter careers in nursing homes, investing over $75 million in financial incentives, such as scholarships and tuition reimbursement.
According to the agency, more than 500,000 direct care workers provide care in nursing homes, assisting residents with daily tasks, such as bathing, dressing, mobility and eating.
"Direct care workers across long-term care settings earn low wages, rarely receive health and retirement benefits, and experience high injury rates," CMS said. "Improving working conditions and wages will lead to improvements in the recruitment and retention of direct care workers and enable nursing staff to provide safer care."
Findings published by the Office of the Assistant Secretary for Planning and Evaluation show that wages for direct care workers trail other entry-level jobs. In 2019, median wages for nursing assistants were lower than the wages of other entry level jobs in 40 states and Washington, D.C. As an example, the median wage for nursing assistants in Louisiana is $10.90 per hour, compared to $13.41 for other entry-level positions.
THE LARGER TREND
According to data from Fitch Ratings earlier this year, nursing facilities reported shortages of 17.3% and 17.7% of nurses and aides, respectively, through the end of February. While high, these figures are well below the peak in January 2022, when 28.3% and 29.8% of nursing facilities reported shortages of nurses and aides.
That said, quit rates are still high. The number of quits in the healthcare and social assistance sector were at 2.7% as of February 2023, compared with the 1.6% average from 2010 to 2019.
ON THE RECORD
"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," said HHS Secretary Xavier Becerra. "When facilities are understaffed, residents suffer. They might be unable to use the bathroom, shower, maintain hygiene, change clothes, get out of bed, or have someone respond to their call for assistance. Comprehensive staffing reforms can improve working conditions, leading to higher wages and better retention for this dedicated workforce."
"CMS is proud to be leading the President's initiative to improve the lives of over 1.2 million residents who reside in Medicare and Medicaid-certified long-term care facilities, and those who will need that care in the future," said CMS Administrator Chiquita Brooks-LaSure. "Today, we took an important first step to propose new staffing requirements that will hold nursing homes accountable and make sure that residents get the safe, high-quality care that they deserve."
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
