In a 2001 report, CMS found that in order to avoid bad outcomes, nursing home residents should each receive at least 4.1 hours of direct nursing care per day. While Medicare and Medicaid reimbursement rates to nursing homes can indirectly influence worker wages, states also can adopt policies to require or incentivize providers to raise wages paid to direct care workers. What did CMS learn from the Request for Information? hide caption. Of the 3.5 hours, no less than 2.2 hours of care must be provided by a certified nursing assistant (CNA) or nurse aide. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. Yet, a recent report concluded that staffing standards in almost every state remain severely low. In April 2022, the National Academies of Science, Engineering, and Medicine recommended minimum staffing levels, policies to ensure competitive wages and benefits, and improvements to staff training and opportunities for career advancement, among other reforms, as part of its comprehensive report to improve nursing home quality. [1] One key initiative within the Presidents strategy is to establish new minimum staffing requirements so every nursing home has sufficient staff who are adequately trained to provide the safe and quality care residents need. 0000007726 00000 n 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 Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. 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. levels. Oregon also authorized facilities to utilize personal care assistants, nursing assistants, physical therapists, and occupational therapists to meet no more than 25 percent of the certified nursing assistant minimum staffing requirement during this time. SPONSORED BY: Massachusetts and North Carolina both direct nursing homes to devote a certain share of the rate increase to direct care staff wages (75% and 80%, respectively). What are the next steps and how can I get involved? Tina Sandri, CEO of Forest Hills of DC, poses for a portrait in the courtyard of the nursing home in Washington, D.C., last week. In a 2001 report, CMS found that in order to avoid bad outcomes, nursing home residents should each receive at least 4.1 hours of direct nursing care per day. Responses are due on June 10, 2022. We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. CMS has advised states to reevaluate their training programs and consider allowing some of the time worked by nursing aides during the public health emergency to count toward the 75-hour training requirement after the waiver ends. hide caption. "In D.C., you can work for Amazon at $19 an hour. Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. 0000000016 00000 n Senator Bob Casey Jr. outlining their concerns about a proposed federal staffing requirement by the Centers for Medicare and Medicaid 2.5 hprd for intermediate care, 3.8 hprd for skilled nursing care. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. Nominate Now. 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. An official website of the United States government. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK [9] Senate Bill 6346 (State of New York) (2021). The new federal staffing requirements would likely increase costs for nursing homes, which could lead to even more closures and cutbacksultimately making it even more difficult for seniors to get the care they need. Fines for noncompliance could be up to $2,000 a day, she said. In addition, the current nursing shortage 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. But those state-level requirements are all lower than what the federal government recommended more than two decades ago, the last time the issue was studied. "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. "They look to you for comfort, but then when you don't have time to adequately give them the comfort they deserve, it's not fair," says Ward. CMS currently posts staffing data for all facilities on the Care Compare website, including resident census data and data on the hours of care provided per resident per day. "It's so that each person gets exactly what they need to be the best they can be and live their best life," says Robyn Grant, director of public policy and advocacy at the Consumer Voice, a group focused on long-term care. 0000034862 00000 n As passed by the House in November 2021, the Build Back Better provisions would have directed the HHS Secretary to study and report to Congress and propose regulations on any appropriate minimum federal nursing staff to resident ratios. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. 0000035796 00000 n 1 Assistant DON RN/LPN full-time. 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. 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. Nursing home staff shortages and high turnover rates among staff are largely attributed to low wages. . Mitigating factors can be considered by the [d]epartment when assessing penalties for non-compliance at a later date., 1199SEIU United Healthcare Workers East, Centers for Medicare & Medicaid Services, CliftonLarsonAllen, CMS, New York State Health Facilities Association. Eric Lee for NPR The law stipulates that 70% of a nursing homes revenue is to be spent on direct resident care and at least 40% spent on staffing. [1] https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/, [2] 87 FR 22720, pages 22771-22772: https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [3] Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule:https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [4] Social Security Act, sections 1819 and 1919, [5] Social Security Act, sections 1128I(g)(4), 1819, and 1919, [6] Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, 2001: https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf; and the 2005 Staff Time and Resource Intensity Verification (STRIVE) Project: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/TimeStudy. 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. 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. Filling the need for trusted information on national health issues, MaryBeth Musumeci , While there are a variety of opinions among stakeholders on establishing minimum staffing requirements, it is CMS goal to consider all perspectives, as well as findings from the staffing study. Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. She aims to have a rule in place within a year, an optimistic time frame given the lengthy federal rulemaking process and other challenges. [7] CMS has historically posted facility staffing metrics on Nursing Home Care (now known as Care Compare), such as the average number of hours worked for nursing staff per resident per day. Federal law authorizes the Health and Human Services (HHS) Secretary to establish requirements relating to nursing home residents health, safety and well-being as conditions for facilities to receive payment from the Medicare and Medicaid programs. "It was a daily struggle before COVID. CMS launched a multi-faceted approach aimed at determining the minimum level and type of staffing needed to enable safe and quality care in nursing homes, which includes conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. The American Health Care Association, which represents 14,000 long-term care facilities, has called into question the administration's authority to enact such a rule without involving Congress. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Hanse told SNN that many facilities have limited or stopped admissions as a result of the staffing crisis, which has noticeably backed up hospital discharges. At least 1.1 hours of care must be given by a registered nurse (RN) or licensed practical nurse (LPN). Sandri struggles to get certified nursing assistants, who typically start at $15.20 an hour, in the door. Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. Published: May 16, 2022. Gov. These states include Oregon and South Carolina. hide caption. Listing for: ProMedica Senior Care. Figure 2 summarizes state activity post-COVID in the areas of minimum staffing requirements, worker wages, and training requirements. In January 2022, CMS began posting data on the level of weekend resident nurses, total nurse staffing, and staff turnover for all nursing homes on the Care Compare website. 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. Despite these existing requirements, understaffing continues to be a concern. 1570 Grant Street. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. 26, 2021); Ltr. Thats according to a report compiled by professional services firm CliftonLarsonAllen (CLA) as part of a partnership with the NYS Health Facilities Association. CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. 0000002362 00000 n 0000008490 00000 n In February, the Biden Administration announced a comprehensive set of reforms to improve the safety and quality of nursing home care. Listed on 2023-03-01. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. Current nursing home staffing requirements by state, While the staffing requirements may be changing, here are the current staffing guidelines, according to the, State Nursing Home Staffing Standards Summary Report. 0000006058 00000 n 2435 0 obj <> endobj xref 0000035309 00000 n Accordingly, using the information described above, https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9, https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf, CMS Drug Spending Dashboards and the Inflation Reduction Act, Addressing Rural Health Inequities in Medicare, The Path Forward: Improving Data to Advance Health Equity Solutions. At least three states (MI, NC, OH) adopted temporary increases or one-time bonuses to nursing home staff wages post-COVID. WebNew Appraisal Review Requirements and Instructions Regarding Department of Veterans Affairs Appraisal Management Service for the Lender Appraisal Processing Program and A minimum of 25% of direct care must be provided by RN/LPN; at least 10% must be provided by RN. Federal government websites often end in .gov or .mil. 0000005687 00000 n Additionally, Missouri now allows third parties to administer the certification test for nursing assistants, which is expected to expedite the process by six to eight weeks. Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 9 STATE STANDARD State [6]What else is included in the study? At least four states adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic (Figure 2 and Appendix Table 2). rV3f2cP!aOI4XX\f3 "c:C]'5x ?(0}CP uzHq8A,7wvVSg`wg 2L@zK2(I~@Za,3X6}z` 7s endstream endobj 2476 0 obj <>/Filter/FlateDecode/Index[154 2281]/Length 67/Size 2435/Type/XRef/W[1 1 1]>>stream While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. In Virginia, House Bill 646 would require the state Board of Health to establish a minimum of 2.8 hours direct care per resident per day for nursing aide staff, and at Home Blog New Nursing Home Minimum Staffing Requirements By State for 2023. Share on Facebook. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. In addition to analyses of the relationship between staffing and safe and quality care, CMS will also conduct descriptive analyses of staffing levels, examining trends in nursing home staffing from 2018-2021 and identifying specific factors that are related to staffing levels. A December 2021 study found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. 0000001884 00000 n Research questions will address not only what level of staffing is needed, but also the impact on quality of care,any barriers to implementation, and any potential unintended consequences of imposing minimum staffing requirements. Among the states that adopted increases, the amount ranged from an additional 0.16 hprd in Connecticut to an additional 3.78 hprd in Rhode Island. In 29 states, including Maryland, the minimum staffing requirement is 3.5 hours or less, according to an analysis by the Consumer Voice. 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