We also examine state legislative and regulatory actions since the onset of the pandemic that directly affect worker wages and training requirements. Initial visits to 50 out of the 75 nursing homes will provide important information to guide the development of the proposed minimum staffing standards, and visits to the remaining 25 facilities will help validate the initial findings as part of CMSs iterative policy process. There is substantial variation in state minimum staffing requirements (Figure 1). 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. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. As part of the staffing study, quantitative analyses will be conducted to identify staffing levels associated with improved quality of care and resident safety in nursing homes. As a nonprofit, Forest Hills of DC doesn't have the bandwidth to raise wages, Sandri says. 0000007275 00000 n 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). Cannot go below 1:40 RN/LPN ratio. 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. Skilled Nursing News is part of the Aging Media Network. 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. The only place that has adopted the federal government's guidance of 4.1 hours of care per day is Washington, D.C. "We think about meeting the numbers every single day," says Tina Sandri, CEO of Forest Hills of DC. 5376 (117th Congress) (2021-2022). Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". As of March 20, 2022, nursing homes were most likely to report a shortage of aides, followed by nursing staff, and least likely to report a shortage of clinical staff. [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. Belle Harris The Department recently made major changes to the state nursing home regulations. 0000007128 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. Some states explicitly require a minimum number of staff hours per resident day, while other states call for nursing homes to provide direct care staff 24 hours per day, seven days per week, without an explicit number of hours per resident requirement. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. As an example, New York proposed a bill to establish nursing home staffing levels, such as 3.5 hours of total nursing care per resident per day, with 1.1 hours of care being required from a licensed nurse.[9]. The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. 0000000016 00000 n 7500 Security Boulevard, Baltimore, MD 21244. 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. 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.. 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. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. Numerous studies over several decades have found that high staffing levels are associated with higher care quality for nursing home residents. Listed on 2023-03-01. New York State Health Facilities Association. The Department of Social Services has made funding available to nursing homes to meet the staffing requirements. Author(s) The Biden Administration has announced plans to propose new federal minimum staffing adequacy regulations in the next year. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. hide caption. hide caption. Eric Lee for NPR 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. 0000002105 00000 n Illinois specified that nursing homes must increase direct care staff wages by $1.00 per hour as of July 2020, and an additional 50 cents per hour as of January 2021. The measures will take effect January 1, 2022. "What has been so ambiguous and subjective is how 'sufficient' is interpreted.". 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). To maintain the highest practicable physical, mental, and psychological well-being of each resident. A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. Although South Carolinas state agency did not explicitly describe the reasons for the temporary change, South Carolina hospitals are experiencing similar difficulty discharging patients to nursing homes due to staffing shortages. Launched in August 2022 and expected to continue through the winter, the staffing study is comprised of four main parts: literature review, site visits, quantitative analyses, and cost analyses all further described below. 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. 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. 0000006448 00000 n When Jordyn's not covering the latest skilled nursing news, she's likely catching a Cubs game at Wrigley Field, cheering on the Iowa Hawkeyes or watching Gilmore Girls all the way through for the millionth time. 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. Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. Another commenter, whose parents live in a nursing home, noted that they visit their parents on a daily basis to ensure the provision of quality care and reported that staff in the facility have stated that they are overworked and understaffed. Nominate a skilled nursing future leader who is raising the bar for patient care in homes & health care facilities across the country. Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. Detailed state-level information is included in the Appendix Tables. Arkansas also adopted a broader definition of the direct care staff whose hours count toward its new minimum staffing requirement, while Rhode Island no longer allows director of nursing hours to count toward its new minimum staffing requirement. But she's also looking into how the taxpayer money pouring into nursing homes, in particular those owned by private equity firms, is being spent. A new law in New York state will require nursing homes to meet minimum standards for staffing and patient care. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. A decade after suffering a stroke that forever changed his life, Maurice Miller has good days and bad ones. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. However, CMS recently announced that this waiver will sunset on June 6, 2022, citing concerns about care quality. WebA skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. 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. 0000009312 00000 n Gov. In the midst of these continuing financial and staffing pressures, providers would be remiss if they did not also consider the existing and prospective regulatory requirements for minimum staffing levels. Some commenters also stated that the following factors should be considered: Medicaid census, facility size, ownership status (profit or non-profit), amount of skilled nursing facility competition in the area, and, community poverty and Medicare census rates. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. The pandemic has taken a substantial toll on people living and working in nursing homes. The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, 0000031136 00000 n In determining what 24-hour services provide sufficient staffmeaning registered nurses (RNs), licensed practical and vocational nurses (LPNs and LVNs), and certified nurse aides (CNAs)facilities must account for individual resident assessments and plans of care, in addition to the facility assessment. Access a large database of nursing staff, making it easy to find the perfect match for your needs. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. Commenters provided robust feedback on the action design and method for implementing a staffing requirement, with some noting that resident acuity could change on a daily basis and recommending that CMS establish benchmarks, rather than absolute values, in staffing requirements. CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. 0000009595 00000 n Listing for: ProMedica Senior 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. Published February 15, 2022 at 8:25 AM EST iStock / The Florida Channel In addition to the 2.5-hour standard, current law also requires that certified nursing assistants and licensed nurses provide a weekly average of 3.6 hours of direct care per patient per day. 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 Innovative talent drives the aging industry forward. https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/, https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched, https://leadingage.org/sites/default/files/LeadingAge%20Letter%20to%20FTC%20-%20staffing%20agencies%20final%2010-8.pdf, Buying Distressed Operations in the Skilled Nursing Facility Space, Distressed Long Term Care Assets: A Lenders Perspective, Regulatory Considerations in Acquisitions of Troubled Long Term Care Facilities, CCPA/CPRA & VCDPA Notice of Collection, Disclosure, & Privacy Policy, Minimum Staffing Requirements for Nursing Homes Pose Regulatory Risks, Increased use of telehealth and telemedicine technologies, especially in light of CMS expanded reimbursement for such services.[10]. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet 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. April 20, 2023 Washington, D.C. 0000034862 00000 n 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. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK Numerous studies have found that high staffing levels are associated with higher care quality. Nursing home administrators also opposed the bill due to an increasing statewide staffing shortage, which was exacerbated by the pandemic. 0000023002 00000 n More information and the registration link for the event is available here: https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. However, the current minimum thresholds for nursing home staffing may soon be changing. Key findings include the following: Staffing Requirements: At least five states (AR, CT, MA, NY, RI) adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least one state (GA) adopted a permanent decrease. 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. [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. To meet the needs of the residents in an appropriate and timely manner. 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. On bad days, something goes wrong and it takes awhile before someone is available to respond to his call button sometimes 45 minutes or longer. Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. 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. , challenges and opportunities facing clinical leaders in skilled nursing News is of! Connecting to the bones. `` leader who is raising the bar for patient care in nursing to. 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