Gov. This brief examines state legislative and regulatory actions since the onset of the pandemic to address nursing home staffing, including minimum staffing requirements, policies that directly affect worker wages (other than increases to provider reimbursement rates), and training requirements. 0000004472 00000 n "Are we using our dollars well? In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. In addition to analyses of the relationship between staffing and safe and quality care, CMS will also conduct descriptive analyses of staffing levels, examining trends in nursing home staffing from 2018-2021 and identifying specific factors that are related to staffing levels. Of course, once CMS issues its proposal for minimum staffing requirements in Spring 2023, that proposal will go through the notice-and-comment rulemaking processproviding further opportunities for all interested parties to weigh in. Current Federal Staffing Requirements: Sufficient Numbers of all nursing staff to meet residents needs. 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. Of the 3.5 hours, no less than 2.2 hours of care must Geriatric Nursing Assistant - GNA. Previously, she covered the legal beat for various publications. 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. Emma Childress , and However, the current minimum thresholds for nursing home staffing may soon be changing. WebA skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. Cannot go below 1:40 RN/LPN ratio. ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". Numerous studies have shown that understaffing nursing homes can harm the health of residents, who suffer more bedsores, more weight loss, more overprescribing of anti-psychotic medications, and during the pandemic more COVID-19 cases and deaths. Turnover at her facility, home to about 100 residents, is nearly triple what it was before the pandemic. LEARN MORE, SPONSORED BY: Before sharing sensitive information, make sure youre on a federal government site. 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. CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. 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. Welcome to the Nursing Home Resource Center! Eric Lee for NPR An official website of the United States government. 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. Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. 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. Federal government websites often end in .gov or .mil. The public comment period closed on June 10, 2022, and CMS received over 3,000 comments from a variety of interested parties including advocacy groups; long-term care ombudsmen; industry associations (providers); labor unions and organizations; nursing home staff and administrators; industry experts and other researchers; family members, and caretakers of nursing home residents. 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. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. Burnout and competition are major factors. 1 DON RN full-time. The bad days are more likely to be those when the facility is short-staffed. She aims to have a rule in place within a year, an optimistic time frame given the lengthy federal rulemaking process and other challenges. (Nov. 22, 2021). 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. 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. Monday Friday: 9am-5pm, New Nursing Home Minimum Staffing Requirements By State for 2023, New federal staffing requirements may be coming. Listed on 2023-03-01. Providers in states from Virginia to New York are pushing back on the requirements they say threaten their ability to provide the best care 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. 98 (D. Nev) (Mar. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. Detailed state-level information is included in the Appendix Tables. 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. WebNursing homes must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. Facilities will be held accountable if they fail to meet this standard. Missouri also established reciprocity standards to allow out-of-state certified nursing assistants (CNAs) to work in Missouri. Before sharing sensitive information, make sure youre on a federal government site. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing new nursing home minimum staffing requirements at a federal level. Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. 0000008490 00000 n By using NurseDash to hire your short-term nurses, you not only wont be paying overtime to your employees, but youll also benefit from fewer fees than standard staffing agencies. CMS should immediately implement requirements for 24/7 registered nurse staffing and a full-time social worker in all nursing homes. Skilled Nursing News is part of the Aging Media Network. In 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. Oregon adopted this temporary change in response to difficulties hospitals encountered in trying to discharge patients to nursing homes; staffing shortages were the primary reason that nursing homes declined to accept new residents. 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. A December 2021 study reviewed state nursing home staffing standards and concluded that staffing standards in almost every state remain severely low. The Medicaid and CHIP Payment and Access Commission (MACPAC) recently reviewed state policies that can help address staffing issues, including increasing Medicaid payment rates, changing Medicaid payment methods to incentivize facilities to devote more revenue to staff, and requiring minimum staffing levels above the federal standard. Still, on some shifts, she has as many as 13 residents to dress, feed, clean, change, move. 0000009595 00000 n Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. 5376 (117th Congress) (2021-2022). These changes apply to all staff and are not limited to providers that participate in Medicaid. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). 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. 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). 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. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. 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. 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. Skilled nursing facilities provide round-the-clock assistance with healthcare and activities of daily living. 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