rV3f2cP!aOI4XX\f3  "c:C]'5x ?(0}CP uzHq8A,7wvVSg`wg 2L@zK2(I~@Za,3X6}z` 7s endstream endobj 2476 0 obj <>/Filter/FlateDecode/Index[154 2281]/Length 67/Size 2435/Type/XRef/W[1 1 1]>>stream For example, the U.S. Department of Justice and the Federal Trade Commission have recently increased enforcement against staffing agencies that price-fix nursing wages, as well as against nursing personnel agencies who engage in price gouging or unfair competition. [8], States have also recently increased scrutiny over minimum nurse staffing levels. 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. An official website of the United States government. How does new federal staffing requirements affect facilities? CMS also received comments on factors impacting facilities ability to recruit and retain staff, with most commenters in support of creating avenues for competitive wages for nursing home staff to address issues of recruitment and retention. Over the next year, policy action is expected on the federal level related to nursing home staffing. The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. [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]. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. NurseDash is an on-demand healthcare marketplace that connects facilities with staffing needs to clinicians looking for open nursing shifts. Federal law authorizes the Health and Human Services (HHS) Secretary to establish requirements relating to nursing home residents health, safety and well-being as conditions for facilities to receive payment from the Medicare and Medicaid programs. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. Facilities will be held accountable if they fail to meet this standard. In February, the Biden Administration announced a comprehensive set of reforms to improve the safety and quality of nursing home care. 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. (Note: For 149 beds, DON may provide direct care and be included in direct care ratios.). 0000034507 00000 n Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. 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. 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. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Michigan enacted a temporary one year increase of $2.35 per hour for direct care staff, including nurses and aides. 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 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, which includes conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. [6], Furthermore, CMS has increased its reporting requirements for nursing homes, public posting of facility staffing measures, and enforcement penalties for nursing homes that do not comply with staffing requirements. Industry commenters stated that staffing in nursing homes has not rebounded as well as it has in other care settings and recruiting remains a challenge, raising concerns that facilities will have to close because they are unable to meet minimum staffing levels. trailer <<3372BD4A84514E1EA1C61D098F46AB0E>]/Prev 308187/XRefStm 1884>> startxref 0 %%EOF 2477 0 obj <>stream 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. "They're tired. 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. 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. We also examine state legislative and regulatory actions since the onset of the pandemic that directly affect worker wages and training requirements. What will the staffing study look like? 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. Other states adopting increases include Arkansas, Massachusetts, and New York. Read on to learn more about the new nursing home minimum staffing requirements and the effect they could have on facilities. [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. However, the bill was voted down in the House Rules Committee four days later. 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 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 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). An official website of the United States government. 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. 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. 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. 0000023002 00000 n Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. Sufficient Numbers of all nursing staff to meet residents needs. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. Listed on 2023-03-01. The Department of Social Services has made funding available to nursing homes to meet the staffing requirements. In 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. 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 a 2001 report, CMS found that in order to avoid bad outcomes, nursing home residents should each receive at least 4.1 hours of direct nursing care per day. WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 9 STATE STANDARD State 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. 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. Hanse told SNN that many facilities have limited or stopped admissions as a result of the staffing crisis, which has noticeably backed up hospital discharges. Alaskas temporary reduction applies during any state-declared public health emergency, not just during the COVID public health emergency. 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. Why hold facilities to a number when there aren't people to fill the jobs? 5 states with the highest-rated nursing homes. Detailed state-level information is included in the Appendix Tables. "It was a daily struggle before COVID. 2435 0 obj <> endobj xref 0000054667 00000 n Milly Silva, the unions executive vice president, said nursing home leadership needs to find effective ways to retain its workers, which will result in better recruiting success. Maurice Miller's call button is attached to his gown. 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. She aims to have a rule in place within a year, an optimistic time frame given the lengthy federal rulemaking process and other challenges. (Nov. 22, 2021). The agency initially published a Request for Information (RFI) soliciting public comments on minimum staffing requirements in April 2022, within the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. "You have an opportunity to save my life," he says. Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. Over 200,000 residents and staff in long-term care facilities have died from COVID-19, comprising more than one in five of all COVID-19 deaths in the U.S.1 Most of these deaths (about 155,000) have occurred in nursing homes that are certified to participate in the Medicare and/or Medicaid programs.2. 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. In 29 states, including Maryland, the minimum staffing requirement is 3.5 hours or less, according to an analysis by the Consumer Voice. 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. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. 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. 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. 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. Some states explicitly require a minimum number of staff hours per resident day, while other states call for nursing homes to provide direct care staff 24 hours per day, seven days per week, without an explicit number of hours per resident requirement. Nominate Now. Federal government websites often end in .gov or .mil. By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. 0000031451 00000 n 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. 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. 0000012942 00000 n But she's also looking into how the taxpayer money pouring into nursing homes, in particular those owned by private equity firms, is being spent. MECHANICSBURG, Pa. (March 1, 2023) LeadingAge PA, an association representing more than 370 aging services providers, including many who operate Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. Current Federal Staffing Requirements: Sufficient Numbers of all nursing staff to meet residents needs. Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. To meet the new staffing requirements, it would take an additional 5,610 additional staff for New York facilities, according to the report. Skilled Nursing News is part of the Aging Media Network. LEARN MORE, SPONSORED BY: Belle Harris Get the latest information, guidance, clarification, instructions, and recent COVID-related policies, Find the latest resources and guidance for people in nursing home and their caregivers, See more on the Providers & CMS Partners page, See more on the Patients & Caregivers page. To maintain the highest practicable physical, mental, and psychological well-being of each resident. 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. 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. 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. 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. 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