In a proposed rule distributed on Sept. 1, 2023, the Centers for Medicare and Medicaid Services (CMS) created new staffing rules for nursing homes. So far, the rules are only a proposal, but nursing homes have until Nov. 6, 2023, to respond with comments.
Although all of the rules are to be implemented in several phases, most nursing homes do not come close to meeting them. KFF estimates that about 80 percent of nursing homes would need to hire additional staff to meet the new requirements.
The plan is the first government commitment to improve health care. TheWhiteHouse.gov says the new plan begins to fulfill President Joe Biden’s Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers signed in April. It aims to provide quality care for healthcare workers, caregivers, seniors needing health care, and people with disabilities. It will also help people going from nursing homes back to their homes.
The Pandemic’s Influence
Many healthcare problems that existed at nursing homes were exposed during the pandemic. The USAToday reports that during COVID-19, more than 200,000 nursing home residents and staff died. Not long ago, business firms started buying homes and reducing staff and care to ensure more profits. They also said that nonprofit nursing homes are three times more likely to provide quality care than for-profit facilities.Presently, only nursing homes in Alaska would meet all of the new proposed requirements. At the other end, only one percent of nursing homes in Louisiana would pass.
The Potential Need for More Nurses
One of the biggest reasons for the increase in nurse hours at nursing homes is that it would reduce health problems and emergency hospital visits if nurses gave each patient more time. An increased presence of nursing staff would allow a more careful evaluation of each patient’s needs.The new proposal does not mention anything about licensed practical nurses (LPNs). It means that LPNs working at a nursing facility may have to be replaced with other staff, including those who may be inexperienced.
The Required Hours
The new requirements establish set hours that medical staff must give each patient. A registered nurse must attend to each patient for 0.55 hours (35 minutes), and nurse assistants must give each patient 2.45 hours of care per day. In addition, each nursing home facility must have a registered nurse present 24/7.Rules already exist that require a registered nurse to be present eight hours daily. Most nursing homes have a LPN on duty for the rest of the day (16 hours). The NH Business Review mentions that some nursing homes must rely on traveling medical staff to meet the current requirements—and they are very expensive.
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A recent loss of nurses and other medical staff due to COVID-19, along with many leaving the medical field, has resulted in a serious shortage of possible staff. Deaths among patients and staff during COVID-19 have led to the call for better rules, which the new ruling intends to meet. More rural areas, in particular, will likely find it hard to meet the new requirements.
A Huge Problem
There are two kinds of nursing homes in the United States—those that are for-profit and those that are nonprofit. While some in both categories have sufficient funds that would enable them to hire more staff, most would not be able to do so.The American Health Care Association, which lobbies for nursing homes, says that the new rules will make it more difficult for seniors to get good medical care in the homes. Most of those in the industry want to see the proposal eliminated.
The Reporting Requirements
Each state will be required to collect information on how each nursing home uses funds from Medicaid. It includes knowing what percentage of Medicaid funds go to pay for their workers. Health and Human Services already has a proposal to understand the hourly pay for workers in home and community-based care to create more uniform pay for those in the industry.Inspections of nursing homes will also occur more frequently, and the information will be available so families can choose the best facilities, staffing, and care for their loved ones. When problems occur and are reported, the CMS will issue fines and ensure the appropriate corrections are made.
More Trained Staff
The CMS’s plan will also help prepare more people to work in the nursing home-care field. There is $75 million available to recruit and train new staff for scholarships and to reimburse tuition costs. Nursing homes already receive about $100 billion from the federal government.The Criticism
Although the proposed plan does provide steps in the right direction, many believe they do not go far enough. The New York Times claims there are about 15,000 nursing homes nationwide and about three quarters of them would need to hire more staff.One of the big questions about the practicality of the proposed rule is where all the new qualified staff will come from. Besides that, nursing homes often pay less than a hospital, and nursing staff work harder than they would at a hospital. It makes it easy for a nurse or nurse’s aide to want to start working at a hospital.
After all the comments are in and evaluated, the CMS will issue a final rule on nursing home requirements for staffing. Urban nursing homes will have less time to comply than rural homes.
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