Feds call for first nursing-home staffing minimums, weaker than industry feared, but homes say it would force some to close

Federal officials' proposed minimum standards for nursing-home staffing are weaker than expected, Bridget Early reports for Inside Health Policy.

The nursing-home industry had anticipated a proposal for about 4.1 hours of employee work time per resident day, meaning that a home with 25 residents would require 18 staffers (times 4.1 hours per resident day = 175 hours per week, divided by 40 hours per week = 17.9 employees).

Instead, the Centers for Medicare and Medicaid Services proposed "minimum nurse staffing standards of 0.55 hours per resident for registered nurses and 2.45 HPRD for nurse aides," as well as a requirement to have a registered nurse at the nursing home around the clock.

"The combined three hours falls short of what a government analysis two decades ago said was the optimal level for quality care: 4.1 hours per day. It also falls short of the 3.76 total hours that a government study said nursing homes currently provide on average," reports Christopher Rowland of The Washington Post.

The proposal is "a long-anticipated response to decades of complaints about neglect and abuse in an industry that critics say is unprepared for the tsunami of seniors heading its way from the Baby Boom," Rowland writes. "Much of the rule would kick in within three years for urban facilities and five years for rural facilities."

The regulation would have major implications for Kentucky, which is farther behind on its nursing-home inspections than any other state but Maryland.

"To address concerns in rural areas where workers are scarce, the Biden administration has provided a series of exemptions in the rule for facilities that can prove they can’t find staff even if they made good faith efforts to recruit and retain workers," Rowland reports. "It plans to pump $75 million into programs intended to bolster the nursing home workforce, such as scholarships and tuition reimbursement."

CMS estimates that the rules would make about three-fourths of nursing homes increase staffing, USA Today reports: "Having enough nurses and aides is the strongest predictor of whether nursing home residents will thrive, researchers have found. But a USA Today investigation last year documented how rarely the federal government enforces decades-old staffing guidelines and rules for nursing homes that participate in Medicare and Medicaid."

The regulation "cleared the White House Office of Management and Budget on Tuesday, Aug. 29, the same day a CMS study underpinning the rule was leaked and created a firestorm among stakeholders," Early reports. "The White House budget office also canceled its two remaining stakeholder meetings on the issue in the wake of the leak. The proposed rule had been pending at OMB since May 30. The two meetings were scheduled for the first and second weeks of September. The meetings were requested by the Organization of Nurse Leaders and the Association of Jewish Aging Services."

Early notes, "The nursing-home industry has lobbied hard against staffing minimums and has called for a White House event to explore alternatives, but patient advocates have backed staffing minimums."

LeadingAge, the largest association for nonprofit nursing homes, told USA Today that the propsoed regulation would be impossible for many nursing homes to meet. “There are simply no people to hire—especially nurses,” said Katie Smith Sloan, the group's president and CEO. “America’s under-funded, long-ignored long-term care sector is in a workforce crisis.” Sloan said nursing homes would have to “reduce admissions or even close” if the rule takes effect.