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Nursing homes that participate in Medicare and Medicaid would have to provide residents with more than 30 minutes of registered nurse (RN) care and almost three hours of care from nurse aides each day under a new federal “safe staffing” proposal released Friday.
The Centers for Medicare and Medicaid Services (CMS) rule would set the first national minimum nurse staffing standards for long-term care facilities. The proposed minimum daily requirements—0.55 hours of RN care (about 33 minutes) and 2.45 hours (about 2 hours and 27 minutes) of nurse aide care—would exceed almost all existing state-level standards and require an estimated 75% of nursing homes to improve their staffing levels.
Nursing homes would also have to have an RN on site 24/7 and complete “robust facility assessments on staffing needs,” according to CMS. And some facilities may require even higher levels of staffing than the proposed minimum.
CMS Administrator Chiquita Brooks-LaSure said the measure, once finalized, would “hold nursing homes accountable” and “improve the lives of over 1.2 million residents who reside in Medicare and Medicaid-certified long-term care facilities.” The rule will undergo public comment through November 6.
CMS is eying certain hardship exemptions and staggered implementation of the proposed minimum standards over two to five years as facilities continue to reel from pandemic-era staffing challenges.
Labor union SEIU International President Mary Kay Henry said the proposal sends the message that “all nursing homes must be held accountable to minimum staffing standards that will keep residents and workers safe, and ensure that public funding is spent in ways that allow caregivers to deliver the best care possible.”
But Ashley Thompson, the American Hospital Association’s SVP of public policy analysis and development, raised concerns that a “one-size-fits-all” staffing minimum “could drive nursing homes to further reduce capacity or close in order to meet the requirements.”
“We are concerned that implementing a numerical staffing threshold in two short years will not resolve the structural healthcare workforce shortages that have been building for more than a decade,” she added in a statement.
Katie Smith Sloan, president and CEO of LeadingAge, a nonprofit aging services provider network that represents nursing homes and other providers, said “it’s meaningless to mandate staffing levels that cannot be met.”
“There are simply no people to hire—especially nurses,” she said in a statement. “The proposed rule requires that nursing homes hire additional staff. But where are they coming from?”