A contentious battle is underway between the Biden administration and the influential nursing home industry over the introduction of a minimum staffing requirement for the nation’s 15,500 nursing homes.
President Biden had previously announced plans for nursing home reforms, with staffing minimums being a key component. However, the specifics of the new rules are still being reviewed and could be released at any time.
Charlene Harrington, a professor emeritus at the University of California at San Francisco who specializes in researching the impact of nursing home staffing on care quality, believes that implementing a reasonable minimum standard after 20 years would make a significant difference.
Advocates have been advocating for minimum staffing requirements for over two decades, arguing that more staff leads to safer and better care for residents. However, the nursing home industry has successfully resisted such requirements until now.
The devastating impact of the coronavirus pandemic on nursing homes, with over 200,000 deaths among residents and staff, has amplified existing concerns and prompted federal action.
Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, acknowledges that the attention nursing homes received during the COVID-19 crisis revealed long-standing issues that need to be addressed.
While the proposed rule has not yet been released, the Centers for Medicare and Medicaid Services (CMS) has been conducting a study since last year to inform the minimum staffing proposal.
However, industry groups argue that any federal standard is unfeasible due to a nationwide staffing shortage, which has been worsened by the pandemic. They also claim that it would become an unfunded federal mandate because Medicaid reimbursement rates are too low.
LeadingAge, an organization representing nonprofit nursing homes, does not explicitly oppose a federal standard but has specific criteria that it wants the government to fulfill before setting a minimum ratio. These criteria include Medicaid covering at least 95 percent of the cost of care and federal assurances of no long-term care workforce shortages.
Advocates believe that solving the workforce shortage and high turnover rates requires making the job more attractive through higher pay and better benefits. They argue that there are people who want to work in the long-term care industry but are deterred by the current conditions.
However, industry groups argue that wages are not the only issue. The pandemic has exacerbated caregiver shortages, and the increasing labor costs combined with Medicaid payment rates that only cover about 86 cents on the dollar create significant financial challenges for nursing homes.
Nursing home staffing rules have remained unchanged since 1987, and there are no official federal standards. Under federal law, facilities are required to provide 24-hour licensed nursing services and utilize registered nurses for at least eight consecutive hours a day, seven days a week. However, experts and advocates argue that the “sufficient” rule is too vague, and facilities have not been held to a high enough standard.
A CMS study in 2001 suggested that facilities should provide a minimum of 4.1 hours of direct care per resident per day to ensure their safety. However, most U.S. nursing homes do not meet this standard, and advocates argue that residents today are generally sicker and require more care than they did 20 years ago.
Staffing-related complaints make up the majority of the complaints received by the Washington, D.C. long-term care ombudsman’s office. Insufficient staffing can lead to serious issues, such as residents only receiving water during mealtimes due to a lack of staff available to assist them throughout the day.
David Grabowski, a long-term care expert and professor of health policy at Harvard Medical School, acknowledges that many nursing homes have staffed below safe and acceptable standards, putting residents’ well-being at risk.
In conclusion, the Biden administration’s proposal for minimum staffing requirements in nursing homes has sparked a heated debate with the industry. Advocates argue that increased staffing is necessary for resident safety and well-being, while industry groups raise concerns about the feasibility and financial implications of implementing a federal standard. The release of the proposed rule is eagerly awaited as stakeholders on all sides continue to voice their opinions.
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