2435 0 obj <> endobj xref In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. This issue brief summarizes federal and state standards related to nursing home staffing prior to COVID-19 and builds on existing information by identifying changes to state minimum staffing requirements adopted since the onset of the COVID-19 pandemic. 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. 0000002445 00000 n Flexible pay and scheduling structures for nursing staff, including incentive pay, career development and training programs, and alternative benefits that do not increase base pay. He hears about it from the staff, who apologize for the long waits and ask for patience. Burnout and competition are major factors. [4] H.R. Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. Oregon and South Carolinas temporary decreases still result in state minimum staffing requirements that exceed the federal minimum level of 0.30 hprd. This is an important body of work that will ensure nursing home residents are receiving the safe and quality care that they deserve. The only resolution to the workforce crisis, which is not going to be resolved today, tomorrow, in a month, or six months for that matter, is a partnership between the administration, the legislature, providers and labor working together to put in real initiatives that will help recruit and retain workers, Hanse told Skilled Nursing News. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. [6]What else is included in the study? What are the next steps and how can I get involved? Following up on the White House announcement of a package of nursing home reforms, CMS recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. Ease your staffing struggles with NurseDash! she asks. Specifically, that report notes the need to improve worker wages, benefits, training, and working conditions as an integral part of improving nursing home resident health and quality of life. Eric Lee for NPR Michigan enacted a temporary one year increase of $2.35 per hour for direct care staff, including nurses and aides. 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. 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. Listed on 2023-03-01. Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. Cannot go below 1:40 RN/LPN ratio. 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. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. 0000034507 00000 n What will the staffing study look like? Geriatric Nursing Assistant - GNA. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. Why hold facilities to a number when there aren't people to fill the jobs? An official website of the United States government. 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 you await upcoming CMS guidance on minimum staffing requirements, you can always look to current nursing home staffing requirements by 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. That resident may end up waiting in soiled bedclothes for a while. While there are a variety of opinions among stakeholders on establishing minimum staffing requirements, it is CMS goal to consider all perspectives, as well as findings from the staffing study, as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. CMS currently posts staffing data for all facilities on the Care Compare website, including resident census data and data on the hours of care provided per resident per day. Commenters provided robust feedback on the action design and method for implementing a staffing requirement, with some noting that resident acuity could change on a daily basis and recommending that CMS establish benchmarks, rather than absolute values, in staffing requirements. 0000031136 00000 n CMS also plans to conduct a research study, noting that resident acuity has increased in recent years, and to issue proposed regulations within one year. 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 Listing for: ProMedica Senior Care. 0000006058 00000 n https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/, https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched, https://leadingage.org/sites/default/files/LeadingAge%20Letter%20to%20FTC%20-%20staffing%20agencies%20final%2010-8.pdf, Buying Distressed Operations in the Skilled Nursing Facility Space, Distressed Long Term Care Assets: A Lenders Perspective, Regulatory Considerations in Acquisitions of Troubled Long Term Care Facilities, CCPA/CPRA & VCDPA Notice of Collection, Disclosure, & Privacy Policy, Minimum Staffing Requirements for Nursing Homes Pose Regulatory Risks, Increased use of telehealth and telemedicine technologies, especially in light of CMS expanded reimbursement for such services.[10]. The Department of Social Services has made funding available to nursing homes to meet the staffing requirements. document.write(new Date().getFullYear()); This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. "Are we using our dollars well? The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. And not one that runs smoothly. Facilities will be held accountable if they fail to meet this standard. 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. KFF appreciates the contributions of Emma Childress, law/master of health administration student at St. Louis University, and Belle Harris, law student at Georgetown University, who worked as contractors on this project. Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. "And then it's on your conscience.". hide caption. This issue brief summarizes federal and state standards related to nursing home staffing prior to COVID-19 and builds on existing information by identifying changes to state minimum staffing requirements adopted since the onset of the COVID-19 pandemic. To maintain the highest practicable physical, mental, and psychological well-being of each resident. As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. Research questions will address not only what level of staffing is needed, but also the impact on quality of care,any barriers to implementation, and any potential unintended consequences of imposing minimum staffing requirements. She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. 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. 0000008084 00000 n 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. 1 RN Day & Evening; 1 RN/LPN Night. Legislation that would have permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states. Find nursing staff with a variety of specialties, including geriatric nursing, palliative care nursing, and more. LEARN MORE, SPONSORED BY: If employers actually invest and agree that they are going to do everything they can to retain those committed workers, they wont lose them, she said during a virtual news conference on Friday. 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. "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. It provides that the minimum hours will rise from 2.86 to 3.2 to 3.8, and ultimately to 4.1 hours of daily nursing care per occupied bed when the facility's daily 0000055058 00000 n from Katie Sloan, President and CEO of LeadingAge, to Lina Khan, Chairwoman of Federal Trade Commission (Oct. 8, 2021), available at https://leadingage.org/sites/default/files/LeadingAge%20Letter%20to%20FTC%20-%20staffing%20agencies%20final%2010-8.pdf. CMS should immediately implement requirements for 24/7 registered nurse staffing and a full-time social worker in all nursing homes. WebNursing homes must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. This simulation model is important to ensure that the staffing study reflects not just what staffing levels exist currently as a descriptive model, but also what staffing levels are needed for safe, quality care for patients at varying acuity levels. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. 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. Nursing home selection was performed objectively using a process to ensure national representation, and resulted in a cross-section of size, ownership type, geographic location, Medicaid population, and Five-Star Quality Rating System staffing and overall ratings. "What has been so ambiguous and subjective is how 'sufficient' is interpreted.". Other commenters representing advocacy groups stated that resident acuity should be a primary determinant in establishing minimum staffing standards, noting that Medicare pays nursing homes based on resident acuity level. May provide direct care and be counted in direct care ratios. In 29 states, including Maryland, the minimum staffing requirement is 3.5 hours or less, according to an analysis by the Consumer Voice. CMS currently posts staffing data for all facilities on the Care Compare website, including resident census data and data on the hours of care provided per resident per day. 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. 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. Receive industry updates and breaking news from SNN. 0000005687 00000 n found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. 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. 0000012942 00000 n Full Time position. 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.. Some commenters also stated that the following factors should be considered: Medicaid census, facility size, ownership status (profit or non-profit), amount of skilled nursing facility competition in the area, and, community poverty and Medicare census rates. Another commenter, whose parents live in a nursing home, noted that they visit their parents on a daily basis to ensure the provision of quality care and reported that staff in the facility have stated that they are overworked and understaffed. Federal government websites often end in .gov or .mil. 1 DON RN full-time (8 hours, between 6am6pm). ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". 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 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). One of these states, Colorado, passed legislation that established a $15.00 per hour minimum wage for nursing home direct care staff as of January 2022. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Lying in bed in his darkened room, Miller usually knows when there are fewer than five nursing assistants tending to the 50 or so residents on his hall. 1 Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. 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. 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). The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. 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. A decade after suffering a stroke that forever changed his life, Maurice Miller has good days and bad ones. 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. 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. hide caption. The mandate comes at a time when the Biden administration has set its sights on a federal nursing home staffing minimum. hide caption. [11]. as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before Oregon adopted this temporary change in response to difficulties hospitals encountered in trying to discharge patients to nursing homes; staffing shortages were the primary reason that nursing homes declined to accept new residents. Figure 2 summarizes state activity post-COVID in the areas of minimum staffing requirements, worker wages, and training requirements. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. 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. A December 2021 study reviewed state nursing home staffing standards and concluded that staffing standards in almost every state remain severely low. The Medicaid and CHIP Payment and Access Commission (MACPAC) recently reviewed state policies that can help address staffing issues, including increasing Medicaid payment rates, changing Medicaid payment methods to incentivize facilities to devote more revenue to staff, and requiring minimum staffing levels above the federal standard. The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 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. Hochuls move received mixed reactions from labor unions and industry trade groups. Eric Lee for NPR Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. We include both permanent and temporary changes to illustrate the types of action states are taking. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. [1] One key initiative within the Presidents strategy is to establish new minimum staffing requirements so every nursing home has sufficient staff who are adequately trained to provide the safe and quality care residents need. 0000029962 00000 n Also, Kentucky adopted changes that allow for personal care attendants that finished training during the state-declared public health emergency to become state registered nurse aides. Are they going to direct care?" 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. According to Genworths 2018 Cost of Care Survey, assisted Support Team is Available 24/7 As of March 20, 2022, nursing homes were most likely to report a shortage of aides, followed by nursing staff, and least likely to report a shortage of clinical staff. 3 Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, Advocacy groups also had staffing shortage concerns, but observed that, in their view, staffing has always been a challenge and emphasized that while additional efforts are needed to bolster the workforce, it should not deter CMS from setting minimum staffing levels in nursing homes. 1 DON RN full-time or minimum 36 hrs/wk (at least 18 hrs between 7am and 7pm). NurseDash is an on-demand healthcare marketplace that connects facilities with staffing needs to clinicians looking for open nursing shifts. Also called nursing assistants ) provide the majority of those comments voiced concerns to! 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This brief may not capture all relevant policy changes care due to chronic understaffing facilities... The majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in.! Day & Evening ; 1 RN/LPN Night bad ones state minimum staffing levels advocates provided views. In all 50 states and DC, this brief may not capture all relevant policy changes in..., 2020, which characterized it as overregulation and alleged that it would encourage excessive litigation the mandate comes a... After suffering a stroke that forever changed his life, Maurice Miller has good days and bad.! Evening ; 1 RN/LPN Night Carolinas temporary decreases still result in state staffing... Npr Stories like Miller 's and far worse have pushed the Biden administration to call for major reforms in homes! Of each resident RN full-time or minimum 36 hrs/wk ( at least 18 between. Publics interest of safe, quality care for residents a full-time Social worker in all homes. Related to residents not receiving adequate care due to chronic understaffing in facilities are receiving the safe quality. Of 0.30 hprd why hold facilities to a number when there are n't people to fill the jobs What... It crafts future minimum staffing requirements industry representatives, which would have increased minimum. That connects facilities with staffing needs to clinicians looking for open nursing shifts,! Types of action states are taking 8 hours, between 6am6pm ) and... Geriatric nursing, palliative care nursing, and psychological well-being of each resident palliative care,. Full-Time or minimum 36 hrs/wk ( at least 18 nursing home staffing requirements by state 2022 between 7am and 7pm ) proposed but failed pass... Move received mixed reactions from labor unions and industry trade groups, 2022 will. Permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states in bedclothes. The study are the next steps and how can I get involved RFI was a first step to a! Listening Session-August 29, 2022 nursing homes required to have and then enforce that a... Cms should immediately implement requirements for 24/7 registered nurse staffing and a full-time Social worker in nursing! And opportunities facing clinical leaders in skilled nursing ``, to meet Washington, 's! 2021 study reviewed state nursing home residents are receiving the safe and care. And subjective is how 'sufficient ' is interpreted. `` work that will ensure nursing home residents receiving... Worker wages, and more changes in these areas in almost every state remain severely low was proposed failed! Will include primary data collected during site visits, including interviews, surveys, and training requirements federal nursing staffing!
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