Detailed state-level information is included in the Appendix Tables. A new law in New York state will require nursing homes to meet minimum standards for staffing and patient care. [8], States have also recently increased scrutiny over minimum nurse staffing levels. She aims to have a rule in place within a year, an optimistic time frame given the lengthy federal rulemaking process and other challenges. She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. The study team is currently reviewing existing literature to summarize the evidence of the relationship between minimum staffing in nursing homes and the safety and quality of care, as well as clarify the relative strengths and weaknesses of the available literature. On bad days, something goes wrong and it takes awhile before someone is available to respond to his call button sometimes 45 minutes or longer. These states include Oregon and South Carolina. Interviews with nursing home leadership, direct care staff (including RNs, LPNs/LVNs, and CNAs), and residents and their family members will be conducted to better understand the relationship between staffing levels, staffing mix (what types of staff are present), and resident outcomes and experiences (i.e., clinical outcomes, safety, health disparities) using rich contextual information collected during the interviews. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA. The law requires every facility to maintain daily staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide, licensed practical nurse or registered nurse. In February, the Biden Administration announced a comprehensive set of reforms to improve the safety and quality of nursing home care. Missouri also established reciprocity standards to allow out-of-state certified nursing assistants (CNAs) to work in Missouri. 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. Geriatric Nursing Assistant - GNA. The bill was voted down two days later in the House Health and Family Services Committee. The only place that has adopted the federal government's guidance of 4.1 hours of care per day is Washington, D.C. "We think about meeting the numbers every single day," says Tina Sandri, CEO of Forest Hills of DC. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. Strengthen staffing, testing and infection control measures at long-term care facilities; and Keep stakeholders informed about the impact of COVID-19 on long-term 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. 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. 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. The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. 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. 0000035945 00000 n Illinois specified that nursing homes must increase direct care staff wages by $1.00 per hour as of July 2020, and an additional 50 cents per hour as of January 2021. Opens in a new window. An official website of the United States government. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. Current nursing home staffing requirements by state, While the staffing requirements may be changing, here are the current staffing guidelines, according to the, State Nursing Home Staffing Standards Summary Report. Before the law even went into effect, of the 611 nursing homes in the state 383 (63%) were considered below 3.5 hours per resident day staffing requirements. [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. Eric Lee for NPR Webduring the 2021 session in section 10 of Public Act 21-185 regarding minimum staffing level requirements for nursing homes. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. What did CMS learn from the Request for Information? At least five states adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least one state adopted a permanent decrease (Figure 2 and Appendix Table 1). As a result, nursing homes have been able to determine what sufficient nursing staff means on their own, which has led to wide variations in nursing home staffing across the countryand as a result, wide variations in the level of care and safety of residents. Quantitative analysis will use secondary data, including Medicare Payroll-based Journal (PBJ) data, Minimum Data Set (MDS), and Medicare claims. Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. Gov. Gov. The Centers for Medicare & Medicaid Services (CMS) has launched a multi-faceted approach aimed at determining the minimum level and type of staffing needed to enable safe and quality care in nursing homes. Before sharing sensitive information, make sure youre on a federal government site. New York State Health Facilities Association. Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. 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]. While Medicare and Medicaid reimbursement rates to nursing homes can indirectly influence worker wages, states also can adopt policies to require or incentivize providers to raise wages paid to direct care workers. LEARN MORE, SPONSORED BY: There are several strategies providers and nursing facilities may consider to comply with the governments increasingly-stringent staffing requirements: Additionally, the government has been cracking down on excessively high costs charged by nurse staffing agencies, which could help providers maintain cost-effectiveness as they continue wrestling with these staffing challenges. [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). In addition to administrative agency action, Congress could adopt legislative changes, though it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation would be included in another budget reconciliation package that is possible this summer. hide caption. Commenters offered recommendations for implementing minimum staffing requirements. 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. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. What are the next steps and how can I get involved? 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 1987 Nursing Home Reform Act, which brought sweeping changes to the industry, requires facilities to have "sufficient" staff so that residents can achieve or maintain their "highest practicable" physical, mental and psychosocial well-being. While you await upcoming CMS guidance on minimum staffing requirements, you can always look to current nursing home staffing requirements by Innovative talent drives the aging industry forward. 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. 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. Federal government websites often end in .gov or .mil. . 0000035697 00000 n The law was first introduced by former Gov. 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. Nursing home staff shortages and high turnover rates among staff are largely attributed to low wages. [1] https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/, [2] 87 FR 22720, pages 22771-22772: https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [3] Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule:https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [4] Social Security Act, sections 1819 and 1919, [5] Social Security Act, sections 1128I(g)(4), 1819, and 1919, [6] Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, 2001: https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf; and the 2005 Staff Time and Resource Intensity Verification (STRIVE) Project: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/TimeStudy. CMS administrator Brooks-LaSure says she's listening to industry concerns, including their call for more money to keep up with rising costs, especially labor. 0000007275 00000 n Over the next year, policy action is expected on the federal level related to nursing home staffing. Providers in states from Virginia to New York are pushing back on the requirements they say threaten their ability to provide the best care While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. hide caption. If youre looking for a nursing staffing solution, look no further than NurseDash. Andrew Cuomo in 2021 as a way to improve nursing home transparency and hold bad actors accountable. 0000002105 00000 n Training: At least 3 states (KY, MO, WI) adopted permanent changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes, while at least 8 states (AK, CT, DE, IA, IN, KS, MO, WI) adopted temporary changes in this area. Mitigating factors can be considered by the [d]epartment when assessing penalties for non-compliance at a later date., 1199SEIU United Healthcare Workers East, Centers for Medicare & Medicaid Services, CliftonLarsonAllen, CMS, New York State Health Facilities Association. This staffing study seeks to help identify a minimum staffing level, which would include RN, LPNs/LVNs, and CNAs, that will establish a threshold below which residents would be at substantially increased risk of not receiving the safe and quality care they deserve. [12] See, e.g., Criminal Indictment, U.S. v. Ryan Hee; and VDA OC, LLC, No. Certified Nurse Aides as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. 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. ATTN: Christine Bates. 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. Detailed state-level information is included in the Appendix Tables. Home Blog New Nursing Home Minimum Staffing Requirements By State for 2023. In some states, the minimum requirement is half the recommended level. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. For example, in three states (Alaska, Hawaii, and North Dakota) and the District of Columbia, fewer than 10 percent of freestanding nursing facilities have 1- or 2- star staffing ratings, while in three other states (Georgia, Louisiana, and In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. [1] A September 2021 survey by the American Health Care Association and the National Center for Assisted Living showed that 86% of nursing homes and 77% of assisted living providers said their workforce situation has gotten worse over the three months preceding the survey. Nursing home resident advocacy groups and family members of residents were generally strongly supportive of establishing a minimum staffing requirement, while other industry and provider groups expressed significant concern. 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. 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. But he is appealing to younger people to consider a job in a nursing home. 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. Two states, Florida and New Jersey, retained their total daily minimum staffing hours but restructured how those hours are allocated across staffing types or shifts post-COVID (Appendix Table 1). "They look to you for comfort, but then when you don't have time to adequately give them the comfort they deserve, it's not fair," says Ward. 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. hide caption. That resident may end up waiting in soiled bedclothes for a while. 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. 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. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. 0000004153 00000 n Insufficient nursing home staffing levels are associated with negative outcomes for residents including increased rates of hospitalization, dehydration, weight loss, and pressure ulcers. 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.. Additionally, observational data will be collected onsite using trained clinicians who will observe and record time spent on care provision, including taking care to differentiate time spent on care provision from time spent on administrative nursing. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. One of these states, Wisconsin, lowered the training hour requirement for nurse aides from 120 hours to the federal minimum of 75 hours. The reforms include minimum staffing requirements and other changes for which resident advocates have long fought. "You have an opportunity to turn this industry on its head. Of the 3.5 hours, no less than 2.2 hours of care must North Carolinas legislature appropriated $1 million for one-time bonus payments to direct care staff, while Ohios legislature appropriated $300 million for wages, incentives, and bonuses to recruit and retain direct care staff. WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 9 STATE STANDARD State At least three other states (IL, MA, and NC) adopted changes that require nursing homes to increase staff wages as a condition of receiving increased Medicaid provider reimbursement rates. The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. 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. Sign up to get the latest information about your choice of CMS topics in your inbox. Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. Nominate Now. But those state-level requirements are all lower than what the federal government recommended more than two decades ago, the last time the issue was studied. Responses are due on June 10, 2022. This equates to 0.30 staffing hours per resident day (hprd).3 Facilities also must designate a full-time registered nurse as a full-time director of nursing. There is substantial variation in state minimum staffing requirements (Figure 1). Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. trailer <<3372BD4A84514E1EA1C61D098F46AB0E>]/Prev 308187/XRefStm 1884>> startxref 0 %%EOF 2477 0 obj <>stream Earlier this year, the White House outlined an ambitious plan to improve the safety and quality of nursing home care, first and foremost by establishing a federal minimum staffing requirement for nursing homes funded through Medicare and Medicaid. The contracted researchers are conducting site visits to 75 nursing homes throughout the country. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. [4] H.R. Two years into the pandemic, he says it's time for them to take care of themselves. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. Skilled Nursing News is part of the Aging Media Network. Or when he misses his wheelchair time because there aren't enough staff to lift him out of bed. Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. Or electronically to: Christine.Bates1@state.co.us. A staff member wearing protective gloves administers eye drop medication to Maurice Miller in his room at the nursing home. 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. How does new federal staffing requirements affect facilities? Arizona introduced HB 2848 on February 11, 2021, which would have increased its minimum staffing requirement. 0000004511 00000 n Numerous studies have found that high staffing levels are associated with higher care quality. 0000008976 00000 n Cannot go below 1:40 RN/LPN ratio. Over the next year, policy action is expected on the federal level related to nursing home staffing. 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. Key findings include the following: Staffing Requirements: At least five states (AR, CT, MA, NY, RI) adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least one state (GA) adopted a permanent decrease. 0000035796 00000 n He hears about it from the staff, who apologize for the long waits and ask for patience. 1 RN Day & Evening; 1 RN/LPN Night. 0000008490 00000 n New Jersey retained its total hprd but now divides the daily minimum to set specific hprd requirements during each of the three shifts in a day. 0000002362 00000 n However, the bill was voted down in the House Rules Committee four days later. In [5] Some States may also have minimum staffing requirements for nursing homes. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. 2435 0 obj <> endobj xref Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. Four of these states (AK, DE, IN, and WI) lowered the training hour requirements for CNAs during the pandemic, in efforts to address staffing issues. This is an important body of work that will ensure nursing home residents are receiving the safe and quality care that they deserve. Maryland, where Ward works, actually does have a minimum staffing requirement for nursing homes, as do most states. 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. 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. A goal of North Carolinas legislation is to raise staff wages to $15.00 per hour; prior to the increase, wages averaged $10.30 per hour. By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. Before sharing sensitive information, make sure youre on a federal government site. The White House on Monday unveiled a slew 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. 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). 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. To inform future staffing requirements, the U.S. Department of Health and Human Services (HHS) should fund research on the minimum and optimum staffing levels for nurses, therapists, recreational Department of nursing & patient care when he misses his wheelchair time there! Home staffing have pushed the Biden Administration announced a comprehensive set of reforms to improve the safety quality... 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