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. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. Andrea Hsu/NPR Taking advantage of governmental funding for additional clinicians, such as the American Rescue Plans National Health Service Corps and Nurse Corps. This effort includes issuing a Request for Information (which occurred earlier this year as a part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. To meet the needs of the residents in an appropriate and timely manner. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. Before sharing sensitive information, make sure youre on a federal government site. 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. These states include Oregon and South Carolina. Cannot go below 1:40 RN/LPN ratio. An official website of the United States government. The contracted researchers are conducting site visits to 75 nursing homes throughout the country. You can be a dog walker for $18 an hour," she says. Two years into the pandemic, he says it's time for them to take care of themselves. Tina Sandri, CEO of Forest Hills of DC, poses for a portrait in the courtyard of the nursing home in Washington, D.C., last week. Site visits to nursing homes and related analyses. The Biden Administration has announced plans to propose new federal minimum staffing adequacy regulations in the next year. Receive industry updates and breaking news from SNN. CMS is also conducting a stakeholder listening session on August 29, 2022 from 1-2:30 p.m. EST to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. 2435 43 Legislation that would have permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states. [10] See, e.g., CY 2022 Medicare Physician Fee Schedule, available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched. 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. Geriatric Nursing Assistant - GNA. ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". 0000008490 00000 n She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. [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. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. 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. Senator Bob Casey Jr. outlining their concerns about a proposed federal staffing requirement by the Centers for Medicare and Medicaid 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. 1 RN Day & Evening; 1 RN/LPN Night. Sufficient Numbers of all nursing staff to meet residents needs. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. 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. The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, 7500 Security Boulevard, Baltimore, MD 21244, By:Pauline Karikari-Martin PhD, MPH, MSN, PHNA-BC, RN Senior Nurse Researcher and Cameron Ingram, MFA Policy Analyst of the Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services Staffing Study to Inform Minimum Staffing Requirements for Nursing Homes, In February 2022, President Biden announced a, 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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. At least three states (MI, NC, OH) adopted temporary increases or one-time bonuses to nursing home staff wages post-COVID. Before sharing sensitive information, make sure youre on a federal government site. For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. 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. 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. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. "And then it's on your conscience.". To attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. "It was a daily struggle before COVID. Alaskas temporary reduction applies during any state-declared public health emergency, not just during the COVID public health emergency. Access a large database of nursing staff, making it easy to find the perfect match for your needs. 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. New York State Health Facilities Association. 0000009595 00000 n 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. Weve heard directly from hospitals their frustration about not being able to discharge people who are not ready to return to the community, he said. Awarded Best of Staffing - Talent 2022 and rated as a Top Workplace 2022 by the Orlando Sentinel, Jackson Nurse Professionals connects today's travel nurse to 0000002105 00000 n It's also a bad day when he cannot call his 94-year-old mother, because his computer has been pushed out of reach. A new law in New York state will require nursing homes to meet minimum standards for staffing and patient care. Skilled Nursing News is part of the Aging Media Network. At least eight states adopted temporary changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes (Appendix Table 3). 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. 0000035796 00000 n However, the bill was voted down in the House Rules Committee four days later. 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. 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. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. He hears about it from the staff, who apologize for the long waits and ask for patience. "It's a bad day when I'm in pain, and I'm not going to get relief in a timely fashion," says Miller, who describes himself as a functional quadriplegic. But he is appealing to younger people to consider a job in a nursing home. 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.. 26, 2021); Ltr. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. Insufficient nursing home staffing levels are associated with negative outcomes for residents including increased rates of hospitalization, dehydration, weight loss, and pressure ulcers. The reforms include minimum staffing requirements and other changes for which resident advocates have long fought. Are there federal nursing home staffing standards currently in place? At least three states adopted temporary wage increases or one-time bonuses for nursing home staff post-COVID. levels. Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before 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. Detailed state-level information is included in the Appendix Tables. [2] In the same survey, more than 7 out of 10 long term care facilities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff.[3]. The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. CMS has advised states to reevaluate their training programs and consider allowing some of the time worked by nursing aides during the public health emergency to count toward the 75-hour training requirement after the waiver ends. Maryland, where Ward works, actually does have a minimum staffing requirement for nursing homes, as do most states. 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. 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. 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. Accordingly, using the information described above, CMS will conduct cost analyses to estimate the cost to nursing homes that would be associated with meeting the new staffing requirement, such as increases in staffing levels or changes to the mix of staff. [2] The COVID-19 Public Health Emergency (PHE) has highlighted and exacerbated the long-standing staffing challenges experienced in many facilities, creating an urgent need to address this issue for the well-being of all individuals residing in our nations federally certified nursing homes and the workers who care for them. [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). 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. 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022 In February, the Biden Administration announced a comprehensive set of reforms to Arkansas also adopted a broader definition of the direct care staff whose hours count toward its new minimum staffing requirement, while Rhode Island no longer allows director of nursing hours to count toward its new minimum staffing requirement. This is an important body of work that will ensure nursing home residents are receiving the safe and quality care that they deserve. 0000007275 00000 n Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). [9] Senate Bill 6346 (State of New York) (2021). Additionally, the federal regulations include a qualitative standard, which requires nursing homes to provide sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident. These regulations were last revised in 1987, while the complexity and acuity of nursing home residents needs has substantially increased since then. Or electronically to: Christine.Bates1@state.co.us. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. 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. Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. Additionally. [4] Additionally, regulations specify that nursing homes are required to conduct an annual facility assessment, which considers resident needs and staff ability to provide care. 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). If LPN is Charge Nurse, RN must be on call. 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. To meet the nursing needs of all residents. Contact us now for staffing assistance. What are the next steps and how can I get involved? document.write(new Date().getFullYear()); We include both permanent and temporary changes to illustrate the types of action states are taking. The law stipulates that 70% of a nursing homes revenue is to be spent on direct resident care and at least 40% spent on staffing. Learn about the latest news, announcements and upcoming events on the topics that are important to you and your business. Other states adopting increases include Arkansas, Massachusetts, and New York. The measures will take effect January 1, 2022. January 1, 2022 must be on call or increased presence of pressure ulcers shown that adequate is... Don RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd ( 24 average! On your conscience. `` in an appropriate and timely manner and worse... Shown by so many stakeholders to date during the RFI process and looks forward to further engagement this... 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While we reviewed Legislation and regulations in all 50 states and DC, this brief may capture. Regulations in all 50 states and DC, this brief may not capture all relevant policy changes is encrypted transmitted. A federal government site elements to inform the minimum staffing requirements post-COVID was but! He says it 's time for them to take care of themselves this is important. Patient care information is included in the Appendix Tables Nurse Corps increased presence of pressure ulcers a... Detailed state-level information is included in the next year two years into the pandemic, according to the of. Two years into the pandemic, he says it 's time for them to take care themselves. Aides averaged $ 11.00 to $ 12.00 per hour residents will go shifts... Include Arkansas, Massachusetts, and New York state will require nursing to! I get involved Committee four days later the contracted researchers are conducting site visits to nursing... 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