Nursing Home Associations Alarmed Over CMS Proposed Rule on Staffing

The Centers for Medicare & Medicaid Services (CMS) estimates that approximately 75 percent of nursing homes would have to beef up staffing at their facilities under a proposed rule which seeks to establish comprehensive staffing requirements for nursing homes, including, for the first time, minimum national nursing staffing standards.

Under the CMS proposal, nursing homes that participate in Medicare and Medicaid would be required to meet specific nursing staffing levels. Nursing homes would be required to provide residents a minimum of 0.55 hours of RN care per resident per day and 2.45 hours of RN care per resident per day, exceeding the existing standards in almost all states.

As the long-term care industry continues to recover from the COVID-19 pandemic, CMS said the proposed standards take into consideration local realities in rural and underserved communities through phased waivers and implementation processes.

But organizations representing the nursing home industry expressed disappointment with the proposed rule.

Mark Parkinson is President and CEO of the American Health Care Association (AHCA), which represents more than 14,000 nursing homes and other long-term care facilities across the country. “It is unfathomable that the Biden Administration is going ahead with this proposed federal staffing mandate. Especially when we learned just a few days ago that CMS’s own study found that there is no single level of staff that ensures quality care,” he said. in a sentence.

“At the same time, nursing homes are facing the worst labor shortage in our industry’s history, and seniors’ access to healthcare is under threat. This unfunded mandate, which will cost billions of dollars every year, will make this growing crisis worse. It requires nursing homes to hire tens of thousands of nurses who just aren’t there,” Parkinson added. “Then it penalizes us and threatens to displace hundreds of thousands of residents when we can’t accomplish the impossible. Hundreds of nursing homes across the United States have already closed due to a lack of workers. We hope to convince the administration to never finalize this rule as it is unfounded, underfunded and unrealistic. We will vigorously advocate for access to care for our nation’s seniors and advocate for common sense solutions to improve quality and strengthen the long-term care workforce.”

Katie Smith Sloan is President and CEO of LeadingAge, a nonprofit association of providers of senior services, including nursing homes. “To say we are disappointed that President Biden has decided to go ahead with the proposed staffing ratios despite clear evidence against him is an understatement. We share the Administration’s goal of ensuring access to quality nursing home care. This proposed rule goes against that shared goal. Unique staff ratios do not guarantee quality, as the Administration’s own Abt research findings made clear. Other than that, there is no point in requiring staffing levels that cannot be met. There are simply no people to hire, especially nurses. The proposed rule requires nursing homes to hire additional staff. But where do they come from? To care for older adults and their families, nursing homes must have the resources, including the staff, to care for them. Without that, there is no care.”

Smith Sloan said mission-based, nonprofit nursing homes will be forced to reduce admissions or even close if the rule is finalized, causing suffering for older Americans and their families.

Soumi Saha, senior vice president of government affairs at supply chain and analytics service provider Premier, issued a statement expressing concern “that the agency’s proposal reflects a lack of understanding of the true state of the workplace environment. Implementing unfunded staffing ratios in any health care setting is absurd given the current job challenges that are occurring across the board, but they are particularly dire in skilled nursing facilities. While the mandatory staffing ratios are well-intentioned, they will likely leave SNF beds empty due to understaffing, exacerbating acute care facility confinement issues and increasing overall costs to the health care system.” .

CMS executives respond that the initiative is focused on improving the lives of more than 1.2 million residents who reside in Medicare and Medicaid-certified long-term care facilities. “Today, we took an important first step in proposing new staffing requirements that will hold nursing homes accountable and ensure residents receive the safe, high-quality care they deserve,” CMS Administrator Chiquita Brooks-LaSure said in a statement. a statement.

Under the proposed rule, nursing homes would also be required to ensure a registered nurse is on-site 24/7 and complete robust facility assessments of staffing needs. Facilities would continue to be required to provide staff that meets the needs of the individual residents they serve, which may require higher staffing levels above the proposed minimum standards.

CMS is also proposing to require states to collect and report workers’ compensation as a percentage of Medicaid payments for those who work in nursing homes and intermediate care facilities. These policies build on recent CMS proposals to support direct care worker compensation in home and community-based settings and to publish Medicaid data on average hourly wage rates for home care workers. The agency said this increased transparency will help efforts to support and stabilize the long-term care workforce in all settings.

In addition, CMS announced a national campaign to support nursing home staffing. As part of the HHS Workforce Initiative. CMS will work with the Health Resources and Services Administration (HRSA) and other partners to make it easier for people to enter their nursing home careers by investing more than $75 million in financial incentives, such as scholarships and tuition reimbursement. This staffing campaign builds on other actions by HHS and the Department of Labor to develop the nursing workforce.

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