Following up on the White House announcement of a package of nursing home reforms, CMS recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. 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. 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. 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. 1 Assistant DON RN/LPN full-time. 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. Oregon and South Carolinas temporary decreases still result in state minimum staffing requirements that exceed the federal minimum level of 0.30 hprd. Create customized staffing solutions that fit your unique needs, which we know can change at any time. 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. It provides that the minimum hours will rise from 2.86 to 3.2 to 3.8, and ultimately to 4.1 hours of daily nursing care per occupied bed when the facility's daily Turnover at her facility, home to about 100 residents, is nearly triple what it was before the pandemic. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. Skilled Nursing News is part of the Aging Media Network. 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. 0000007304 00000 n Legislation that would have permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet nursing needs of [their] residents and must use the services of a registered professional nurse at least 8 consecutive hours a day, seven days a week. Holly Ward has worked as a geriatric nursing assistant at a nursing home in Baltimore for four years. That resident may end up waiting in soiled bedclothes for a while. In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. States can choose to adopt staffing or training requirements that are stricter than federal rules as part of their role in licensing nursing home providers and administering state Medicaid programs, which finance the majority of nursing home care. 0000035697 00000 n Nursing home staff shortages and high turnover rates among staff are largely attributed to low wages. This staffing study seeks to help identify a minimum staffing level, which would include RN, LPNs/LVNs, and CNAs, that will establish a threshold below which residents would be at substantially increased risk of not receiving the safe and quality care they deserve. hide caption. It also states that nursing home operators in the state are required to return all profits in excess of 5% to the state, regardless of the quality of care or whether the operator sustained losses in prior years. 5376 (117th Congress) (2021-2022). Thats according to a report compiled by professional services firm CliftonLarsonAllen (CLA) as part of a partnership with the NYS Health Facilities Association. 0000008490 00000 n 0000031451 00000 n Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. Denver, CO 80203. The 1987 Nursing Home Reform Act, which brought sweeping changes to the industry, requires facilities to have "sufficient" staff so that residents can achieve or maintain their "highest practicable" physical, mental and psychosocial well-being. WebThe monthly median cost of assisted living in Virginia is $4,451, which is higher than the national average of $4,000. Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. Increased adoption of automatic technologies or administrative processes such as patient intake, consent management, payment processing, and appointment scheduling, to reduce staff workload. 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. To meet the needs of the residents in an appropriate and timely manner. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. Skilled Nursing News The agency initially published a Request for Information (RFI) soliciting public comments on minimum staffing requirements in April 2022, within the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. 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. As a result, nursing homes have been able to determine what sufficient nursing staff means on their own, which has led to wide variations in nursing home staffing across the countryand as a result, wide variations in the level of care and safety of residents. 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. If LPN is Charge Nurse, RN must be on call. 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. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. Often, to meet the basic needs of every resident, Ward says she ends up skipping other important components of their care, such as talking with them and providing emotional support. Must have 1 RN who is full-time DON (5 days/wk); if fewer than 60 residents, DON may also be Charge Nurse. 0000034862 00000 n Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. Home Blog New Nursing Home Minimum Staffing Requirements By State for 2023. [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. [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. Of the 3.5 hours, no less than 2.2 hours of care must 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. Contact us now for staffing assistance. 0000023002 00000 n Belle Harris May provide direct care and be counted in direct care ratios. WebNursing homes must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. Burnout and competition are major factors. CMS should immediately implement requirements for 24/7 registered nurse staffing and a full-time social worker in all nursing homes. Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. Top Characteristics of a Successful Nursing Student and How to Improve Them, Ultimate Guide to Nursing School Must-Haves, Prioritizing Self-Care: A Guide for Nursing Students, 4 Great Takeaways From Our Latest Fireside Chat About College Financial Aid, Top Nursing Tips: How to Make 2023 Your Best Year Yet. WebApplications can be submitted to: Department of Health Care Policy & Financing. It is even more so now.". She aims to have a rule in place within a year, an optimistic time frame given the lengthy federal rulemaking process and other challenges. This brief examines state legislative and regulatory actions since the onset of the pandemic to address nursing home staffing, including minimum staffing requirements, policies that directly affect worker wages (other than increases to provider reimbursement rates), and training requirements. Other commenters representing advocacy groups stated that resident acuity should be a primary determinant in establishing minimum staffing standards, noting that Medicare pays nursing homes based on resident acuity level. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. CMS administrator Brooks-LaSure says she's listening to industry concerns, including their call for more money to keep up with rising costs, especially labor. Here, you'll find our nursing home resources, including COVID-19 public health emergency response information. Still, on some shifts, she has as many as 13 residents to dress, feed, clean, change, move. An official website of the United States government. Based on the federal government's 5-star rating system for nursing homes from November 2022, Hawaii has the best average score (3.90 across 41 facilities), followed by Alaska (3.80, 20 facilities), Idaho (3.46, 78 facilities), Delaware (3.35, 43 facilities), and Utah (3.34, 96 facilities). Welcome to the Nursing Home Resource Center! Geriatric Nursing Assistant - GNA. These changes apply to all staff and are not limited to providers that participate in Medicaid. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. [12] Going forward, providers would be well-served to keep in mind these and any other regulatory staffing requirements. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. 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. All of the states adopting permanent minimum staffing changes post-COVID, including Georgia with its decrease, continue to exceed the federal minimum staffing requirement of 0.30 hours per resident day. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. Facilities can post open shifts that result from job vacancies, sickness, vacations, or even an increase in minimum staffing requirements and nurses can choose the shifts that work best for them, in their desired location. Support Team is Available 24/7 Sign up to get the latest information about your choice of CMS topics in your inbox. [2] In the same survey, more than 7 out of 10 long term care facilities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff.[3]. Stephen Hanse, New York State Health Facilities Association president and CEO, said the laws do not reflect the current reality of New Yorks long-term care landscape, calling it unworkable.. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. hA 04Pk\GczC. It's also a bad day when he cannot call his 94-year-old mother, because his computer has been pushed out of reach. "To care for them, you have to give them dignity. Although setting minimum staffing requirements could have a positive impact on the overall quality of care and resident satisfaction, the financial impact could be devastating for some facilities. The feedback received has and will be used to inform the research study design and proposals for minimum direct care staffing requirements in nursing homes in 2023 rulemaking. All rights reserved. Others pointed to the variability of the various states Medicaid labor reimbursement and suggested that Medicaid rates in many states do not keep pace with rising labor costs. Other states adopting increases include Arkansas, Massachusetts, and New York. In It provides that the minimum hours will rise from 2.86 to 3.2 to 3.8, and ultimately to 4.1 hours of daily nursing care per occupied bed when the facility's daily reimbursement reaches the current required rate ($94.11) plus its actual audited costs above that rate and the costs of increasing the staff-to-resident hours. At least three states adopted permanent changes to staff training requirements to expand the pool of staff available to work in nursing homes post-COVID (Figure 2 and Appendix Table 3). Milly Silva, the unions executive vice president, said nursing home leadership needs to find effective ways to retain its workers, which will result in better recruiting success. 0000013059 00000 n We include both permanent and temporary changes to illustrate the types of action states are taking. Filling the need for trusted information on national health issues, MaryBeth Musumeci , 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. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. The agency initially published a Request for Information (RFI) soliciting public comments on minimum staffing requirements in April 2022, within the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. 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. There is substantial variation in state minimum staffing requirements (Figure 1). "You have an opportunity to turn this industry on its head. 0000009312 00000 n Despite these existing requirements, understaffing continues to be a concern. According to Genworths 2018 Cost of Care Survey, assisted Nursing home administrators also opposed the bill due to an increasing statewide staffing shortage, which was exacerbated by the pandemic. [2] The COVID-19 Public Health Emergency (PHE) has highlighted and exacerbated the long-standing staffing challenges experienced in many facilities, creating an urgent need to address this issue for the well-being of all individuals residing in our nations federally certified nursing homes and the workers who care for them. Insufficient nursing home staffing levels are associated with negative outcomes for residents including increased rates of hospitalization, dehydration, weight loss, and pressure ulcers. Specifically, Florida retained its total hprd but increased the number of licensed practical nurse hours and decreased the number of certified nursing assistant hours that count toward the overall total. By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK For example, in three states (Alaska, Hawaii, and North Dakota) and the District of Columbia, fewer than 10 percent of freestanding nursing facilities have 1- or 2- star staffing ratings, while in three other states (Georgia, Louisiana, and Cannot go below 1:40 RN/LPN ratio. There are several strategies providers and nursing facilities may consider to comply with the governments increasingly-stringent staffing requirements: Additionally, the government has been cracking down on excessively high costs charged by nurse staffing agencies, which could help providers maintain cost-effectiveness as they continue wrestling with these staffing challenges. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. While the staffing requirements may be changing, here are the current staffing guidelines, according to the State Nursing Home Staffing Standards Summary Report for the markets supported by NurseDash. Some commenters suggested that CMS focus on implementing an acuity staffing model per shift instead of a minimum staffing requirement, while some recommended a staff to patient ratio instead. Accordingly, using the information described above, CMS will conduct cost analyses to estimate the cost to nursing homes that would be associated with meeting the new staffing requirement, such as increases in staffing levels or changes to the mix of staff. (Nov. 22, 2021). 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. 0000004511 00000 n [6], Furthermore, CMS has increased its reporting requirements for nursing homes, public posting of facility staffing measures, and enforcement penalties for nursing homes that do not comply with staffing requirements. Also, you can decide how often you want to get updates. The Centers for Medicare & Medicaid Services is expected to conduct a study to determine the level and type of staffing needed, and propose a new federal standard within one year, the agency confirmed during a stakeholder call on March 10. The CLA report found that it would cost anywhere from $250,000 to $1.6 million in annual costs per facility that is below the newly imposed staffing requirements. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. "You have an opportunity to save my life," he says. 7500 Security Boulevard, Baltimore, MD 21244, By:Pauline Karikari-Martin PhD, MPH, MSN, PHNA-BC, RN Senior Nurse Researcher and Cameron Ingram, MFA Policy Analyst of the Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services Staffing Study to Inform Minimum Staffing Requirements for Nursing Homes, In February 2022, President Biden announced a, The Centers for Medicare & Medicaid Services (CMS) has 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. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. This issue brief summarizes federal and state standards related to nursing home staffing prior to COVID-19 and builds on existing information by identifying changes to state minimum staffing requirements adopted since the onset of the COVID-19 pandemic. A goal of North Carolinas legislation is to raise staff wages to $15.00 per hour; prior to the increase, wages averaged $10.30 per hour. "They're tired. On some days, she has as many as 13 residents to care for on a shift. Author(s) 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. 0000012942 00000 n At least three states (MI, NC, OH) adopted temporary increases or one-time bonuses to nursing home staff wages post-COVID. The law requires every facility to maintain daily staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide, licensed practical nurse or registered nurse. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing new nursing home minimum staffing requirements at a federal level. 0000008976 00000 n Gov. But he is appealing to younger people to consider a job in a nursing home. Or when he misses his wheelchair time because there aren't enough staff to lift him out of bed. In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. Share on Facebook. Learn about the latest news, announcements and upcoming events on the topics that are important to you and your business. Also, Kentucky adopted changes that allow for personal care attendants that finished training during the state-declared public health emergency to become state registered nurse aides. 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