Wages: At least four states (CO, IL, MA, NC) adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic. Others pointed to the variability of the various states Medicaid labor reimbursement and suggested that Medicaid rates in many states do not keep pace with rising labor costs. The Department of Social Services has made funding available to nursing homes to meet the staffing requirements. 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. How does new federal staffing requirements affect facilities? However, CMS recently announced that this waiver will sunset on June 6, 2022, citing concerns about care quality. In response to the COVID-19 public health emergency, CMS temporarily waived the training requirement as a means of addressing potential staffing shortages during the pandemic. We include both permanent and temporary changes to illustrate the types of action states are taking. Following up on the White House announcement of a package of nursing home reforms, the Centers for Medicare and Medicaid Services (CMS) recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. 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. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. The mandate comes at a time when the Biden administration has set its sights on a federal nursing home staffing minimum. If LPN is Charge Nurse, RN must be on call. Massachusetts and North Carolina both direct nursing homes to devote a certain share of the rate increase to direct care staff wages (75% and 80%, respectively). Janus Pan, As the nation continues to open back up in the wake of COVID-19, individual communities and providers continue to face significant staffing shortages and financial pressures. 1 DON RN full-time (8 hours, between 6am6pm). hide caption. WebStaffing rates by state Overall, nursing facility staffing rates vary widely across states (Figure 1). 0000035945 00000 n 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. For example, in three states (Alaska, Hawaii, and North Dakota) and the District of Columbia, fewer than 10 percent of freestanding nursing facilities have 1- or 2- star staffing ratings, while in three other states (Georgia, Louisiana, and Job A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. 0000036022 00000 n To meet the needs of the residents in an appropriate and timely manner. The pandemic has taken a substantial toll on people living and working in nursing homes. They're physically exhausted, and even committed people in this industry will turn around and say, 'I don't know how much longer I can do this,'" says Sandri. Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. (Note: For 149 beds, DON may provide direct care and be included in direct care ratios.). 0000006860 00000 n Ease your staffing struggles with NurseDash! The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. 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. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. Over the next year, policy action is expected on the federal level related to nursing home staffing. 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. By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. Belle Harris 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. At least two states adopted temporary decreases to minimum staffing requirements post-COVID to account for potential staffing issues during the pandemic (Appendix Table 1). 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. Holly Ward has worked as a geriatric nursing assistant at a nursing home in Baltimore for four years. Current nursing home staffing requirements by state, While the staffing requirements may be changing, here are the current staffing guidelines, according to the, State Nursing Home Staffing Standards Summary Report. States can choose to adopt staffing or training requirements that are stricter than federal rules as part of their role in licensing nursing home providers and administering state Medicaid programs, which finance the majority of nursing home care. ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. Cannot go below 1:40 RN/LPN ratio. Webduring the 2021 session in section 10 of Public Act 21-185 regarding minimum staffing level requirements for nursing homes. 0000009595 00000 n Kathy Hochul lifted a three-month pause on Friday. One after another. Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. "Are we using our dollars well? 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. We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. As a nonprofit, Forest Hills of DC doesn't have the bandwidth to raise wages, Sandri says. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. In some states, the minimum requirement is half the recommended level. Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. 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. Share on Facebook. 7500 Security Boulevard, Baltimore, MD 21244. is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. 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. The Centers for Medicare & Medicaid Services is expected to conduct a study to determine the level and type of staffing needed, and propose a new federal standard within one year, the agency confirmed during a stakeholder call on March 10. 0000006058 00000 n 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. Quantitative analysis will use secondary data, including Medicare Payroll-based Journal (PBJ) data, Minimum Data Set (MDS), and Medicare claims. 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. 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. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. The only place that has adopted the federal government's guidance of 4.1 hours of care per day is Washington, D.C. "We think about meeting the numbers every single day," says Tina Sandri, CEO of Forest Hills of DC. Others recommended that minimum staffing levels be established for residents with the lowest care needs, assessed using the MDS 3.0 assessment forms, citing concerns that acuity-based minimums will be more susceptible to gaming. Nominate a skilled nursing future leader who is raising the bar for patient care in homes & health care facilities across the country. 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. As an example, New York proposed a bill to establish nursing home staffing levels, such as 3.5 hours of total nursing care per resident per day, with 1.1 hours of care being required from a licensed nurse.[9]. Ward will find that while she's attending to one resident, another is incontinent. 3 Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, 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. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. 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. 2435 43 Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. The contracted researchers are conducting site visits to 75 nursing homes throughout the country. 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. 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. 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