The White House announced Monday that the nursing home minimum staffing rule has been finalized.
In fact, the rule requires all nursing homes that receive Medicare and Medicaid funding to meet a certain staffing threshold at all times. The U.S. Centers for Medicare & Medicaid Services (CMS) first proposed the minimum staffing requirement last fall.
“Medicare and Medicaid pay billions of dollars each year to ensure that the 1.2 million Americans receiving care in nursing homes are cared for, yet too many nursing homes are chronically understaffed in their facilities, resulting in substandard or unsafe care,” a fact stated by the White House paper on Monday.
Although the minimum staffing requirement does not apply to home care services, all home care providers should be aware of it as its finalization is likely to complicate work dynamics in the post-acute care sector. Home care providers and nursing homes often compete head-to-head in their markets to recruit for clinical positions, and nursing homes may now be forced to be more aggressive in recruiting and retaining staff.
Home Health Care News confirmed last year that CMS had no immediate plans to make a similar staffing proposal for home care providers.
The minimum staffing regulation is primarily intended to improve care for nursing home residents, but the Biden administration also hopes to compensate for employee burnout.
“This rule not only benefits residents and their families, but also ensures that workers are not overburdened by inadequate on-site staffing, which is currently a common cause of worker burnout and turnover,” the fact sheet continues .
Specifically, the regulation requires a minimum of 3.48 hours per resident per day of total nursing home staffing, with specific allocations for registered nurses (RNs) and nursing assistants. For each resident per day, staffing requirements include 0.55 hours for registered nurses and 2.45 hours for registered nurses.
This means facilities with 100 residents will need at least two to three nurses and 10 to 11 nursing assistants per shift, along with two additional nursing assistants, who may be registered nurses, licensed professional nurses, or nursing assistants.
“Many facilities would need to hire more staff based on the needs of their residents,” the White House said in its fact sheet. “It will also require facilities to have a trained nurse on-site 24 hours a day, seven days a week to provide skilled care, which will further improve safety in nursing homes.”
The nursing home staffing rules stem from a comprehensive package of planned nursing home reforms that the White House first released in 2022.
According to the Biden administration, the rule will be phased in gradually, with longer timelines for rural communities. There will be “limited, temporary exceptions” to certain aspects of the rule, but these will only apply to “nursing homes in labor shortage areas that are making good faith efforts to recruit employees.”
In the White House fact sheet highlighting that the nursing home minimum staffing rule has been finalized, the Biden administration also announced that CMS will move forward with the so-called Medicaid 80-20 rule.
The final rule, “Ensuring Access to Medicaid Services,” requires at least 80% of Medicaid payments for home care services to go toward employee wages.
Several industry associations representing senior care providers have already criticized both developments on Monday.
“Two major issues – the lack of qualified candidates and the cost of hiring and training staff – mean that implementation of the nursing home final rule will likely limit older adults and families’ access to care and services,” said Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “As it relates to the Medicaid Access Rule, the lack of infrastructure to collect and report accurate information, funding to meet additional resource needs, and data to ensure funds are distributed as intended will impact access to health care. Furthermore, given these deficiencies, there is no guarantee that this rule will increase workers’ compensation.”
Additional reporting by Shelby Grebbin.