The Biden administration has proposed new rules for nursing home staffing, aiming to address the industry’s troubling performance during the COVID-19 pandemic. However, these new rules have fallen short of the demands of both the nursing home industry and patient advocates.
Under the proposed rules by the Centers for Medicare and Medicaid Services (C.M.S.), all nursing facilities would be required to increase their staff to meet certain minimum levels. However, the proposal does not include any additional funding for nursing homes to cover the cost of hiring new staff.
C.M.S. estimates that around three-quarters of the nation’s 15,000 nursing homes would need to hire more workers. But for many of these facilities, the required increase in staffing would be minor, as the average nursing home already employs nurses and aides at or close to the proposed levels.
The Biden administration has stated that nursing homes would be exempt from punishment if they can demonstrate a local worker shortage and genuine efforts to recruit employees. However, both the industry and patient advocates believe that the proposed standard is inadequate to meet the needs of nursing home residents.
Executives in the nursing home industry argue that without additional funding from Medicare or Medicaid, which are the main federal insurers for nursing home care, meeting the staffing requirement would be financially unfeasible. They emphasize that there is already a shortage of available personnel, particularly nurses, making it challenging to hire additional staff as required.
According to the proposed rule, nursing homes would need to have a daily average of at least 0.55 hours of nurse staffing per resident, equivalent to one registered nurse for every 44 residents. However, the average nursing home already provides 0.66 hours of nurse staffing per resident. Additionally, at least one registered nurse would need to be on duty at all times, a significant change from the current requirement of eight consecutive hours of nursing coverage each day.
The proposed rule also calls for 2.45 nurse-aide hours per resident per day, indicating a ratio of around one aide for every ten residents. While there are no specific federal staffing requirements for nurse aides, the average nursing home already provides 2.22 nurse-aide hours per day.
The nursing home industry argues that it cannot afford to pay higher wages due to insufficient reimbursement from state Medicaid programs. On the other hand, patient advocates point out that some for-profit nursing homes are providing substantial returns to investors, highlighting disparities in funding allocation.
The proposed staffing standards are projected to cost nursing homes an additional $4 billion in three years, excluding rural homes, which would have a timeline of five years to comply. Medicare and Medicaid spent $95 billion on nursing home care and retirement community care in 2021, according to C.M.S.
To help improve recruitment and staffing in nursing homes, the Biden administration has offered $75 million in scholarships and tuition as part of the proposal. However, the industry contends that more comprehensive measures are needed, such as educational subsidies for long-term care workers, loan forgiveness, and career advancement opportunities.
The proposed rules are currently open for public comments for the next 60 days before they are finalized. While aiming to address staffing inadequacies in nursing homes, the proposed changes have not fully satisfied industry and patient advocate demands, raising concerns about their effectiveness in improving care for nursing home residents.
