The federal government announced today that it will establish staffing levels for nursing homes for the first time in response to the systemic issues highlighted by the mass COVID-19 deaths. While this regulation has been long sought by advocates for older adults and individuals with disabilities, the proposed threshold is lower than expected and has drawn criticism from the nursing home industry.
President Joe Biden, in his 2022 State of the Union speech, stated, “We are working to ensure the safety of nursing home residents is not sacrificed for profit.” However, the American Health Care Association (AHCA), which represents care facilities, called the proposal “unfathomable” and argued that it would exacerbate existing problems and impose steep financial burdens on homes.
Under the proposed rules, nursing homes would be required to maintain staffing equivalent to 3 hours per resident per day, with registered nurses accounting for just over half an hour of that time. Additionally, facilities would be mandated to have a registered nurse on staff 24 hours a day, every day.
While the average U.S. nursing home already has caregiver staffing levels of about 3.6 hours per resident per day, including RN staffing just above the half-hour mark, the government argues that the majority of nursing homes would still need to increase their staff.
Chiquita Brooks-LaSure, the head of the Centers for Medicare and Medicaid Services (CMS), described this move as “an important first step,” while a senior White House official stated that the administration is open to reassessing the staffing threshold once it’s implemented.
Some advocates expressed disappointment with the proposed thresholds, stating that they fall short of the desired levels. They argue that the 2001 CMS-funded study recommended an average of 4.1 hours of nursing care per resident daily, which most facilities do not meet. They also emphasize that the proposed rules do not adequately consider the residents’ quality of life and potential harm.
The COVID-19 pandemic shed light on the issue of poor staffing in nursing homes, which resulted in over 167,000 deaths among residents. Despite this, many nursing homes saw their staffing levels decrease further in the aftermath of the pandemic.
The current law requires nursing homes to have “sufficient” staffing, but the interpretation is left to individual states. Thirty-eight states and the District of Columbia have their own staffing regulations, which advocates argue are often ineffective due to low standards and lax enforcement.
Front-line nurse aides and residents themselves have long been aware of the staffing problems, with calls for assistance going unanswered and basic needs being neglected. The nursing home industry has campaigned to address these issues, citing insufficient Medicaid subsidies, hiring difficulties, and closures. However, critics argue that if the industry provided better pay, it would attract more workers.
Some industry representatives, such as Katie Smith Sloan, the head of LeadingAge, which represents nonprofit nursing homes, argue that it is impractical to require additional hires when there is already a shortage of qualified staff.
In conclusion, while the federal government’s decision to regulate staffing levels in nursing homes is seen as a positive step by some, there are concerns about the proposed thresholds and their feasibility. The debate over staffing standards and the overall improvement of the nursing home industry is ongoing.
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