April 2024:
The MLO Minute: “New Federal Rule Announces Minimum Staffing Levels for Nursing Homes”
By Dennis McAndrews, Esq., and Kelly Hayes, Esq. —
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) set minimum staffing levels for nursing homes for the first time under a new rule establishing comprehensive staffing requirements. The rule will require facilities to have a registered nurse on site at all times. The announcement came in response to concerns about the adequacy of care in nursing homes in general, as well as, the number of nursing home deaths since the COVID-19 pandemic (over 185,000). The pandemic highlighted long-term problems in nursing homes, including the decline in staffing, issues regarding infection control deficiencies and inadequate oversight.
According to a White House fact sheet, the new rule which was proposed in September by CMS, would require nursing homes that receive funding through Medicaid and Medicare provide the staffing equivalent of at least 3.48 hours of nursing care per resident, per day, including 0.55 hours of care from a registered nurse and 2.45 hours of care from a nurse aide each day. A registered nurse will need to be on site 24 hours a day, seven days a week, to provide skilled nursing care at the facilities, which are home to about 1.2 million people nationwide, according to the new rule.
Many nursing home facilities will need to hire additional staff to meet the new requirements. A facility with 100 residents would need two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift to meet the new standards.
Current law requires facilities to have licensed nursing services around the clock that are “sufficient” to “maintain the highest practicable physical, mental, and psychosocial well-being of each resident.” The new staffing requirements will be introduced in phases, with rural communities given a longer time to comply. Limited, temporary exemptions also will be available for the around-the-clock nurse requirement and the staffing standards in areas where there are workforce shortages and a good faith effort to hire.
Nursing home industry groups said the new rule and requirements will be hard to meet because of staff shortages, but advocates for nursing home groups disagreed. Minimum staffing requirements will “help protect the basic rights of residents to live in dignity” and is long overdue, especially for facilities that are funded through taxpayer dollars, Nancy LeaMond, AARP’s Executive Vice President and Chief Advocacy and Engagement Officer, said in a statement. “Far too many residents and families have experienced tragic consequences because of poorly staffed facilities,” LeaMond said in the statement, adding that “ensuring nursing homes are adequately staffed will improve the quality of care residents receive and can give family caregivers peace of mind, knowing their loved ones are living with the quality of life they deserve.”
Sources: CMS and AARP
