The Biden administration is setting new standards for the daily amount of time a nursing home resident receives direct care from a nurse or health aide.
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The Biden administration is setting new standards for the daily amount of time a nursing home resident receives direct care from a nurse or health aide.
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The Biden administration finalized nursing home staffing rules Monday that will force thousands of them to hire more nurses and health care aides — while giving them years to do so.
The new rules from the Centers for Medicare & Medicaid Services constitute the most substantial changes to federal oversight of the nation’s approximately 15,000 nursing homes in more than three decades. But they are less stringent than patient advocates say is necessary to provide high-quality care.
Spurred by the disproportionate number of COVID-19 deaths in long-term care facilities, the rules aim to address ongoing staffing shortages that can lead to missed diagnoses, serious pressure sores and frequent falls .
“For residents, this will mean more staff, which potentially means fewer emergency room visits, more independence,” Vice President Kamala Harris said during a meeting with nursing home workers in La Crosse , Wisconsin. “For families, this means peace of mind when it comes to caring for your loved one.”
When the regulations are fully adopted, 4 out of 5 households will need to increase their payroll, CMS estimated. But the new standards will likely require slight improvements, if any, for many of the 1.2 million residents in facilities that are already pretty close to or meeting the minimum levels.
‘Established a floor’
“Historically, it’s a big deal, and we’re happy that we’ve now established a floor,” Blanca Castro, California’s long-term care ombudsman, said in an interview. “From there we can move forward, recognizing that there are going to be a lot of complaints about how we’re going to recruit more people to fill these positions.”
The rules primarily concern staffing levels for three types of nursing home workers. Registered nurses, or registered nurses, are the most knowledgeable and responsible for directing overall care and establishing treatment plans. Licensed practical nurses, sometimes called licensed vocational nurses, work under the direction of registered nurses and perform routine medical care such as taking vital signs. Certified nursing assistants are expected to be outnumbered and help residents with daily activities like going to the bathroom, dressing, and eating.
While the sector has increased wages by 27% since February 2020, homes say they still struggle to compete with the higher-paying work of nurses in hospitals and in retail stores and restaurants for caregivers. On average, nursing home registered nurses make $40 per hour, licensed practical nurses make $31 per hour and nursing assistants make $19 per hour, according to the most recent data from the Bureau of Labor Statistics.
CMS estimated that the rules would ultimately cost $6 billion a year, but the plan omits any other payments from Medicare or Medicaid, the public insurers that cover most residents’ stay — meaning the additional wages would have to come from pockets of owners or budgets of existing facilities.
“Unfunded mandate”
The American Health Care Association, which represents the nursing home industry, called the regulations an “unreasonable standard” that “creates an impossible task for providers” amid a persistent nursing home workforce shortage. national scale.
“This unfunded mandate does not magically solve the nursing crisis,” the association’s CEO Mark Parkinson said in a statement. Parkinson said the industry will continue to pressure Congress to roll back the regulations.
Richard Mollot, executive director of the Long Term Care Community Coalition, a New York-based nonprofit, said “it’s hard to call this a victory for nursing home residents and families,” given that the minimum levels were lower than what the studies found. be ideal.
The plan was welcomed by unions that represent nurses — and that President Joe Biden is counting on to support him in his re-election campaign. Service Employees International Union President Mary Kay Henry called it a “long overdue sea change.” That political connection was underscored by the administration’s decision to ask Harris to announce the rule with SEIU members in Wisconsin, a swing state.
The new rules replace a vague federal mandate in place since the 1980s requiring nursing homes to have “sufficient” staff to meet the needs of residents. In practice, inspectors rarely classified understaffing as a serious infraction that could result in penalties, federal records show.
Starting at age two, most homes will need to provide an average of at least 3.48 hours of daily care per resident. Around 6 out of 10 nursing homes already operate at this level, according to a KFF analysis.
CMS also required that within two years, a registered nurse be on duty at all times in the event of a patient’s seizure on weekends or at night. Currently, CMS requires at least eight consecutive hours of registered nurse presence each day and a registered nurse of any level on duty 24 hours a day. An inspector general report found that nearly a thousand nursing homes did not meet these basic requirements.
The rules give households some breathing room before having to comply with more specific requirements. Within three years, most nursing homes will be required to provide daily nursing care of at least 0.55 hours per resident and 2.45 hours by nursing assistants.
Nursing homes in rural areas will have more time to recruit staff. Within three years, they must meet overall staffing and 24-hour RN requirements. The CMS rule states that rural homes have four years to meet the RN and RN thresholds. nurse’s aide, although there was some confusion within CMS because its press materials indicated that rural homes would be five years old.
Under the new rules, an average nursing home, which has about 100 residents, should have at least two nurses working each day and at least 10 or 11 nurse aides, the administration said. Homes could meet the overall requirements with two additional workers, who could be registered nurses, vocational nurses or health care aides.
Homes may qualify for an exemption from the financial hardship minimums if they are in areas with low populations of nurses or caregivers and demonstrate good faith in recruiting.
Democrats praised the rules, although some said the administration had not gone far enough. Rep. Lloyd Doggett (D-Texas), ranking member of the House Health Ways and Means Subcommittee, said the changes were “modest improvements” but “much more is needed to ensure sufficient care.” and the safety of residents. A Republican senator from Nebraska, Deb Fischer, said the rule would “devastate nursing homes across the country and worsen the staffing shortages we already face.”
Advocates for nursing home residents have been pressuring CMS for years to adopt a higher standard than the one it ultimately settled on. A study commissioned by CMS in 2001 found that quality of care improved as staffing increased to a level of 4.1 hours per resident per day, nearly a fifth more than that. that CMS will need. Consultants hired by CMS to prepare its new rules did not incorporate previous findings into their evaluation of options.
Threats of closure, siphoned profits
CMS said the levels it approved were more financially feasible for homes, but that assertion did not quell the ongoing battle over how many people are willing to work in homes at current wages and financial strain real estate owners.
“If states don’t increase Medicaid payments to nursing homes, facilities will close,” said John Bowblis, an economics professor and researcher at the Scripps Gerontology Center at the University of Miami. “There aren’t enough workers and there are shortages everywhere. When we have an unemployment rate of 3 to 4%, where are we going to put people to work in retirement homes?”
Researchers, however, are skeptical that all nursing homes are as bankrupt as the industry claims or as their books show.
A study released in March by the National Bureau of Economic Research estimated that 63 percent of profits were secretly diverted to landlords through inflated rents and other fees paid to other companies owned by nursing home investors.
Charlene Harrington, professor emeritus at the University of California San Francisco School of Nursing, said: “In its uncontrolled pursuit of profits, the nursing home industry has created its own problems by not paying salaries. and adequate benefits and imposing heavy workloads on nurses. that cause neglect and harm to residents and create an unsatisfactory and stressful work environment.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the primary operating programs of KFF, an independent source of health policy research, polling and journalism. Learn more about KFF.
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