While staffing shortages in nursing homes have existed for decades, the COVID-19 pandemic has highlighted and intensified the need for sufficient, consistent, trained staff to care for residents. The law was first introduced by former Gov. If DON has institutional responsibilities, add 1 Assistant DON RN full-time. In February 2022, President Biden announced a comprehensive set of reforms to improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed care choices. Kathy Hochul lifted a three-month pause on Friday. 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. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. It also states that nursing home operators in the state are required to return all profits in excess of 5% to the state, regardless of the quality of care or whether the operator sustained losses in prior years. 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. We received many comments on the RFI from members of the public identifying themselves as family members or caretakers of residents living in nursing homes. found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 0000023002 00000 n 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. 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. Eric Lee for NPR While the staffing requirements may be changing, here are the current staffing guidelines, according to the State Nursing Home Staffing Standards Summary Report for the markets supported by NurseDash. Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. Listed on 2023-03-01. [5] Some States may also have minimum staffing requirements for nursing homes. 0000029962 00000 n In Are there federal nursing home staffing standards currently in place? Two years into the pandemic, he says it's time for them to take care of themselves. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Oregon also authorized facilities to utilize personal care assistants, nursing assistants, physical therapists, and occupational therapists to meet no more than 25 percent of the certified nursing assistant minimum staffing requirement during this time. 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. Some commenters suggested that CMS focus on implementing an acuity staffing model per shift instead of a minimum staffing requirement, while some recommended a staff to patient ratio instead. 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]. 0000002408 00000 n 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. Once the state-declared public health emergency ends, these nurse aides are not required to complete additional training. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. 0000002362 00000 n Federal regulations require nursing homes to provide licensed nursing services 24 hours a day, with a registered nurse on staff for at least eight consecutive hours a day, seven days a week. Following up on the White House announcement of a package of nursing home reforms, the Centers for Medicare and Medicaid Services (CMS) recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. Support Team is Available 24/7 Federal government websites often end in .gov or .mil. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. Commenters offered recommendations for implementing minimum staffing requirements. To meet the new staffing requirements, it would take an additional 5,610 additional staff for New York facilities, according to the report. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. However, the current minimum thresholds for nursing home staffing may soon be changing. The government has increased scrutiny and staffing requirements in response to COVID-19. Also, you can decide how often you want to get updates. The Biden Administration recently announced plans to propose new federal minimum staffing adequacy regulations in the next year. 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.. This simulation model is important to ensure that the staffing study reflects not just what staffing levels exist currently as a descriptive model, but also what staffing levels are needed for safe, quality care for patients at varying acuity levels. 0000030078 00000 n 0000034507 00000 n The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. To meet the nursing needs of all residents. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. When pushed, a light goes on in his room, above his door, and at the nurses' station at his nursing home in Takoma Park, Md. Federal law authorizes the Health and Human Services (HHS) Secretary to establish requirements relating to nursing home residents health, safety and well-being as conditions for facilities to receive payment from the Medicare and Medicaid programs. . 0000009595 00000 n document.write(new Date().getFullYear()); 0000007275 00000 n Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. 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. When Jordyn's not covering the latest skilled nursing news, she's likely catching a Cubs game at Wrigley Field, cheering on the Iowa Hawkeyes or watching Gilmore Girls all the way through for the millionth time. These states include Oregon and South Carolina. Detailed state-level information is included in the Appendix Tables. The White House on Monday unveiled a slew While Congress could adopt legislative changes, it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation that passed the House would be included in a potential budget reconciliation package that could be considered this summer. Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. Specifically, that report notes the need to improve worker wages, benefits, training, and working conditions as an integral part of improving nursing home resident health and quality of life. A December 2021 study found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. [2] State of the Long Term Care Industry: Survey of nursing home and assisted living providers show industry facing significant workforce crisis, American Health Care Association, National Center for Assisted Living (September 2021), available at https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf. Andrew Cuomo in 2021 as a way to improve nursing home transparency and hold bad actors accountable. What will the staffing study look like? 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. We also examine state legislative and regulatory actions since the onset of the pandemic that directly affect worker wages and training requirements. However, there has never been a federally required minimum number of staffing hours per resident day, despite repeated calls to establish one from researchers and patient advocates over the last several decades. Opens in a new window. Nursing home selection was performed objectively using a process to ensure national representation, and resulted in a cross-section of size, ownership type, geographic location, Medicaid population, and Five-Star Quality Rating System staffing and overall ratings. But she's also looking into how the taxpayer money pouring into nursing homes, in particular those owned by private equity firms, is being spent. Others pointed to the variability of the various states Medicaid labor reimbursement and suggested that Medicaid rates in many states do not keep pace with rising labor costs. However, CMS recently announced that this waiver will sunset on June 6, 2022, citing concerns about care quality. CMS should immediately implement requirements for 24/7 registered nurse staffing and a full-time social worker in all nursing homes. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. 1 DON RN full-time. It is even more so now.". Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. umw=@em;o~mvwnyes,>xyOmoK]q6rk^/B xc6@0 Specifically, Florida retained its total hprd but increased the number of licensed practical nurse hours and decreased the number of certified nursing assistant hours that count toward the overall total. States can choose to adopt staffing or training requirements that are stricter than federal rules as part of their role in licensing nursing home providers and administering state Medicaid programs, which finance the majority of nursing home care. Other commenters representing advocacy groups stated that resident acuity should be a primary determinant in establishing minimum staffing standards, noting that Medicare pays nursing homes based on resident acuity level. These data will enable the development of a simulation model to examine the impact of different staffing levels and patient acuity levels on the quality and timeliness of care. April 20, 2023 Washington, D.C. However, the bill was voted down in the House Rules Committee four days later. At least two states (OR, SC) adopted temporary decreases to account for potential staffing issues during the pandemic. Full Time position. CMS also received comments on factors impacting facilities ability to recruit and retain staff, with most commenters in support of creating avenues for competitive wages for nursing home staff to address issues of recruitment and retention. Geriatric Nursing Assistant - GNA. At least 1.1 hours of care must be given by a registered nurse (RN) or licensed practical nurse (LPN). If employers actually invest and agree that they are going to do everything they can to retain those committed workers, they wont lose them, she said during a virtual news conference on Friday. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. ". The feedback received has and will be used to inform the research study design and proposals for minimum direct care staffing requirements in nursing homes in 2023 rulemaking. 0000013059 00000 n Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. Or when he misses his wheelchair time because there aren't enough staff to lift him out of bed. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA. Bradley attorneys can assist with the full spectrum of healthcare regulatory and employment matters, or with any other matter that arises in the long-term care space. Sufficient Numbers of all nursing staff to meet residents needs. The CLA report found that it would cost anywhere from $250,000 to $1.6 million in annual costs per facility that is below the newly imposed staffing requirements. Hanse told SNN that many facilities have limited or stopped admissions as a result of the staffing crisis, which has noticeably backed up hospital discharges. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. Or electronically to: Christine.Bates1@state.co.us. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. 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. 0000031792 00000 n 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. Before sharing sensitive information, make sure youre on a federal government site. The reforms include minimum staffing requirements and other changes for which resident advocates have long fought. Federal government websites often end in .gov or .mil. Author(s) Get the latest information, guidance, clarification, instructions, and recent COVID-related policies, Find the latest resources and guidance for people in nursing home and their caregivers, See more on the Providers & CMS Partners page, See more on the Patients & Caregivers page. If youre looking for a nursing staffing solution, look no further than NurseDash. 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 While federal requirements state that facilities must maintain sufficient nursing staff to meet residents needs, specific guidelines are not set and state regulations vary drastically. As the White House considers stricter federal staffing minimum requirements, regulations in some parts of the country are bowing to the realities of the skilled nursing industrys workforce crisis.. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. [12] See, e.g., Criminal Indictment, U.S. v. Ryan Hee; and VDA OC, LLC, No. 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. Over the next year, policy action is expected on the federal level related to nursing home staffing. hide caption. 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. 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. In addition, the current nursing shortage could also make it difficult for facilities to find and retain high-quality nursing staff, which would reduce the number of residents that facility could support. This article briefly outlines a sample of such minimum staffing regulations, as specifically applied to nurses, and also offers some potential cost-effective ideas for maintaining a minimum level of required nursing staff. One after another. The Centers for Medicare and Medicaid Services (CMS) announced in November 2021 increased oversight of nursing services pursuant to 42 CFR 483.35, which mandates sufficient nursing staff at facilities receiving Medicare reimbursement: The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facilitys resident population in accordance with the facility assessment required at 483.70(e).[5], Specifically, CMS will survey nursing homes in the future for nurse competency, inappropriate use of antipsychotic medications, and other areas of residents health and concern. 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