2435 0 obj <> endobj xref Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. Before sharing sensitive information, make sure youre on a federal government site. Among the states that adopted increases, the amount ranged from an additional 0.16 hprd in Connecticut to an additional 3.78 hprd in Rhode Island. ". Numerous studies over several decades have found that high staffing levels are associated with higher care quality for nursing home residents. Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. Additionally. 0000008976 00000 n 0000035796 00000 n Accordingly, using the information described above, https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9, https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf, CMS Drug Spending Dashboards and the Inflation Reduction Act, Addressing Rural Health Inequities in Medicare, The Path Forward: Improving Data to Advance Health Equity Solutions. In Virginia, House Bill 646 would require the state Board of Health to establish a minimum of 2.8 hours direct care per resident per day for nursing aide staff, and at from Katie Sloan, President and CEO of LeadingAge, to Lina Khan, Chairwoman of Federal Trade Commission (Oct. 8, 2021), available at https://leadingage.org/sites/default/files/LeadingAge%20Letter%20to%20FTC%20-%20staffing%20agencies%20final%2010-8.pdf. Current nursing home staffing requirements by state, While the staffing requirements may be changing, here are the current staffing guidelines, according to the, State Nursing Home Staffing Standards Summary Report. document.write(new Date().getFullYear()); Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. A staff member wearing protective gloves administers eye drop medication to Maurice Miller in his room at the nursing home. [2] In the same survey, more than 7 out of 10 long term care facilities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff.[3]. [2] The COVID-19 Public Health Emergency (PHE) has highlighted and exacerbated the long-standing staffing challenges experienced in many facilities, creating an urgent need to address this issue for the well-being of all individuals residing in our nations federally certified nursing homes and the workers who care for them. Maurice Miller's call button is attached to his gown. she asks. One of these states, Colorado, passed legislation that established a $15.00 per hour minimum wage for nursing home direct care staff as of January 2022. . As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. Federal government websites often end in .gov or .mil. Over 200,000 residents and staff in long-term care facilities have died from COVID-19, comprising more than one in five of all COVID-19 deaths in the U.S.1 Most of these deaths (about 155,000) have occurred in nursing homes that are certified to participate in the Medicare and/or Medicaid programs.2. In addition to administrative agency action, Congress could adopt legislative changes, though it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation would be included in another budget reconciliation package that is possible this summer. State Actions to Address Nursing Home Staffing During COVID-19, most likely to report a shortage of aides, staffing standards in almost every state remain severely low, must designate a full-time registered nurse as a full-time director of nursing, sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum, require a minimum number of staff hours per resident day, he primary reason that nursing homes declined to accept new residents, experiencing similar difficulty discharging patients to nursing homes due to staffing shortages, unpopular among nursing home industry representatives. 0000005687 00000 n The government has increased scrutiny and staffing requirements in response to COVID-19. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. "Are we using our dollars well? Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. "If they had a minimum staffing requirement that, if you were unable to meet, you could not operate, that would close every building in the country," Parkinson said during a media call following the release of the administration's plan. KFF appreciates the contributions of Emma Childress, law/master of health administration student at St. Louis University, and Belle Harris, law student at Georgetown University, who worked as contractors on this project. 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. If youre looking for a nursing staffing solution, look no further than NurseDash. 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. 0000002362 00000 n The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. Despite these existing requirements, understaffing continues to be a concern. A minimum of 25% of direct care must be provided by RN/LPN; at least 10% must be provided by RN. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022 In February, the Biden Administration announced a comprehensive set of reforms to 0000006448 00000 n The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. Yet, a recent report concluded that staffing standards in almost every state remain severely low. In April 2022, the National Academies of Science, Engineering, and Medicine recommended minimum staffing levels, policies to ensure competitive wages and benefits, and improvements to staff training and opportunities for career advancement, among other reforms, as part of its comprehensive report to improve nursing home quality. To attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. 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. CMS currently posts staffing data for all facilities on the Care Compare website, including resident census data and data on the hours of care provided per resident per day. It means that you have to confront issues around wages, issues around benefits, issues around working conditions and what it means to have a safe working environment for the caregivers.. For example, in three states (Alaska, Hawaii, and North Dakota) and the District of Columbia, fewer than 10 percent of freestanding nursing facilities have 1- or 2- star staffing ratings, while in three other states (Georgia, Louisiana, and Responses are due on June 10, 2022. In a statement provided to Skilled Nursing News, the state Department of Health said, at this time, nursing homes should appropriately document their efforts to comply with the law. Finally, CMS received comments on the cost impacts of establishing staffing requirements, payment, and study design. Hochuls move received mixed reactions from labor unions and industry trade groups. 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. Receive industry updates and breaking news from SNN. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. CMS administrator Brooks-LaSure says she's listening to industry concerns, including their call for more money to keep up with rising costs, especially labor. trailer <<3372BD4A84514E1EA1C61D098F46AB0E>]/Prev 308187/XRefStm 1884>> startxref 0 %%EOF 2477 0 obj <>stream As a nonprofit, Forest Hills of DC doesn't have the bandwidth to raise wages, Sandri says. Hochul originally delayed implementation of the mandates, citing the industrys staffing challenges made worse by the omicron variant. Find nursing staff with a variety of specialties, including geriatric nursing, palliative care nursing, and more. Connecticut and Kansas adopted changes that allow temporary nurse aides to work, though Connecticuts temporary executive order has expired. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. The bill was voted down two days later in the House Health and Family Services Committee. 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. 1 DON RN full-time or minimum 36 hrs/wk (at least 18 hrs between 7am and 7pm). In April 2022, the National Academies of Science, Engineering and Medicine recommended minimum staffing levels, policies to ensure competitive wages and benefits, and improvements to staff training and opportunities for career advancement, among other reforms, as part of its comprehensive report to improve nursing home quality. Wages: At least four states (CO, IL, MA, NC) adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic. But those state-level requirements are all lower than what the federal government recommended more than two decades ago, the last time the issue was studied. Eric Lee for NPR They're burned out. 1 RN Day & Evening; 1 RN/LPN Night. Share on Facebook. To meet the new staffing requirements, it would take an additional 5,610 additional staff for New York facilities, according to the report. The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. Often, to meet the basic needs of every resident, Ward says she ends up skipping other important components of their care, such as talking with them and providing emotional support. Nursing homes across the state of New York must now abide by a new law that requires facilities to meet minimum staffing levels after Gov. For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. CMS currently posts staffing data for all facilities on the Care Compare website, including resident census data and data on the hours of care provided per resident per day. Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. Full Time position. CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK The bad days are more likely to be those when the facility is short-staffed. 0000036022 00000 n 0000035309 00000 n [1] https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/, [2] 87 FR 22720, pages 22771-22772: https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [3] Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule:https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [4] Social Security Act, sections 1819 and 1919, [5] Social Security Act, sections 1128I(g)(4), 1819, and 1919, [6] Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, 2001: https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf; and the 2005 Staff Time and Resource Intensity Verification (STRIVE) Project: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/TimeStudy. hA 04Pk\GczC. Helen Schaub, the unions policy and legislative director, said during the virtual news conference that the health department will view payroll based journal (PBJ) data to ensure nursing homes are complying with the laws. [12] Going forward, providers would be well-served to keep in mind these and any other regulatory staffing requirements. Research questions will address not only what level of staffing is needed, but also the impact on quality of care,any barriers to implementation, and any potential unintended consequences of imposing minimum staffing requirements. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. Nursing home staff shortages and high turnover rates among staff are largely attributed to low wages. Senator Bob Casey Jr. outlining their concerns about a proposed federal staffing requirement by the Centers for Medicare and Medicaid The Department recently made major changes to the state nursing home regulations. The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident 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. Others recommended that minimum staffing levels be established for residents with the lowest care needs, assessed using the MDS 3.0 assessment forms, citing concerns that acuity-based minimums will be more susceptible to gaming. Monday Friday: 9am-5pm, New Nursing Home Minimum Staffing Requirements By State for 2023, New federal staffing requirements may be coming. While there are a variety of opinions among stakeholders on establishing minimum staffing requirements, it is CMS goal to consider all perspectives, as well as findings from the staffing study, as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. The Centers for Medicare & Medicaid Services is expected to conduct a study to determine the level and type of staffing needed, and propose a new federal standard within one year, the agency confirmed during a stakeholder call on March 10. As of March 27, 2022, more than one in four nursing homes nationally reported a shortage of at least one type of staff, though the share of nursing homes reporting staffing shortages varies widely by state. This effort includes issuing a Request for Information (which occurred earlier this year as a part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule[3]) and conducting a new study. We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. Two years into the pandemic, he says it's time for them to take care of themselves. 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. "It was a daily struggle before COVID. The law stipulates that 70% of a nursing homes revenue is to be spent on direct resident care and at least 40% spent on staffing. The Department of Social Services has made funding available to nursing homes to meet the staffing requirements. is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. Advocacy groups also had staffing shortage concerns, but observed that, in their view, staffing has always been a challenge and emphasized that while additional efforts are needed to bolster the workforce, it should not deter CMS from setting minimum staffing levels in nursing homes. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. Cannot go below 1:40 RN/LPN ratio. New York State Health Facilities Association. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. It's also a bad day when he cannot call his 94-year-old mother, because his computer has been pushed out of reach. The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that reflects resident census, acuity, case mix and residents professional nursing needs as determined by their assessments and care plans. We include both permanent and temporary changes to illustrate the types of action states are taking. Interviews with nursing home leadership, direct care staff (including RNs, LPNs/LVNs, and CNAs), and residents and their family members will be conducted to better understand the relationship between staffing levels, staffing mix (what types of staff are present), and resident outcomes and experiences (i.e., clinical outcomes, safety, health disparities) using rich contextual information collected during the interviews. found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. That resident may end up waiting in soiled bedclothes for a while. "They look to you for comfort, but then when you don't have time to adequately give them the comfort they deserve, it's not fair," says Ward. 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). "You have an opportunity to save my life," he says. 0000007726 00000 n hide caption. Arizona introduced HB 2848 on February 11, 2021, which would have increased its minimum staffing requirement. as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. Weve heard directly from hospitals their frustration about not being able to discharge people who are not ready to return to the community, he said. 0000002408 00000 n Here, you'll find our nursing home resources, including COVID-19 public health emergency response information. 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]. The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that Facilities can post open shifts that result from job vacancies, sickness, vacations, or even an increase in minimum staffing requirements and nurses can choose the shifts that work best for them, in their desired location. The Biden Administration recently announced plans to propose new federal minimum staffing adequacy regulations in the next year. The Biden administration is planning to establish a federal minimum staffing requirement for nursing homes as part of a broader push to improve care for seniors and people with disabilities. Site visits to nursing homes and related analyses. Mitigating factors can be considered by the [d]epartment when assessing penalties for non-compliance at a later date., 1199SEIU United Healthcare Workers East, Centers for Medicare & Medicaid Services, CliftonLarsonAllen, CMS, New York State Health Facilities Association. ATTN: Christine Bates. Support Team is Available 24/7 Over the next year, policy action is expected on the federal level related to nursing home staffing. "You have an opportunity to turn this industry on its head. Listing for: ProMedica Senior Care. The new federal staffing requirements would likely increase costs for nursing homes, which could lead to even more closures and cutbacksultimately making it even more difficult for seniors to get the care they need. (Note: For 149 beds, DON may provide direct care and be included in direct care ratios.). A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 98 (D. Nev) (Mar. May provide direct care and be counted in direct care ratios. 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]. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. An official website of the United States government. 0000012942 00000 n WebThe Manager of an ALR must: Be at least 21 years old Have experience in administration, supervision, and management Have a Bachelor's degree or equivalent experience in human services management, housing management, or nursing home management The Manager must be of good moral character and must never have been convicted of a felony. Andrew Cuomo in 2021 as a way to improve nursing home transparency and hold bad actors accountable. It provides that the minimum hours will rise from 2.86 to 3.2 to 3.8, and ultimately to 4.1 hours of daily nursing care per occupied bed when the facility's daily For that reason, CMS believes it essential to patient safety that it conduct the new rulemaking to establish more specific, detailed, and quantitative minimum staffing requirements. Also, Kentucky adopted changes that allow for personal care attendants that finished training during the state-declared public health emergency to become state registered nurse aides. [9] Senate Bill 6346 (State of New York) (2021). Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. Before the law even went into effect, of the 611 nursing homes in the state 383 (63%) were considered below 3.5 hours per resident day staffing requirements. The Biden administration is planning to establish a federal minimum staffing requirement for nursing homes as part of a broader push to improve care for seniors and people with disabilities. There are several strategies providers and nursing facilities may consider to comply with the governments increasingly-stringent staffing requirements: Additionally, the government has been cracking down on excessively high costs charged by nurse staffing agencies, which could help providers maintain cost-effectiveness as they continue wrestling with these staffing challenges. In response to the COVID-19 public health emergency, CMS temporarily waived the training requirement as a means of addressing potential staffing shortages during the pandemic. [5] Some States may also have minimum staffing requirements for nursing homes. In some states, the minimum requirement is half the recommended level. 0000006860 00000 n Although setting minimum staffing requirements could have a positive impact on the overall quality of care and resident satisfaction, the financial impact could be devastating for some facilities. Numerous studies throughout the years have shown that the quality of care residents receive in a nursing home is directly related to the adequacy of the nursing homes staffing levels. 0000031451 00000 n 0000004038 00000 n All of the states adopting permanent minimum staffing changes post-COVID, including Georgia with its decrease, continue to exceed the federal minimum staffing requirement of 0.30 hours per resident day. Before sharing sensitive information, make sure youre on a federal government site. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. At least two states adopted temporary decreases to minimum staffing requirements post-COVID to account for potential staffing issues during the pandemic (Appendix Table 1). Skilled Nursing News Of the 3.5 hours, no less than 2.2 hours of care must be provided by a certified nursing assistant (CNA) or nurse aide. , not replace, previous studies qualitative analysis will include primary data collected during site,. The New York ) ( 2021 ) Some states, the requirements are vague and not adequate for seniors. Hours a day aides to work, though Connecticuts temporary executive order expired. Staff member wearing protective gloves administers eye drop medication to Maurice Miller in room! The kentucky Bill was voted down two days later in the next year kentucky Bill voted... Managed and paid for by the U.S. Centers for Medicare & Medicaid Services which characterized it as and... 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