[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. 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. Increased adoption of automatic technologies or administrative processes such as patient intake, consent management, payment processing, and appointment scheduling, to reduce staff workload. Eric Lee for NPR Accordingly, using the information described above, https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9, https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf, CMS Drug Spending Dashboards and the Inflation Reduction Act, Addressing Rural Health Inequities in Medicare, The Path Forward: Improving Data to Advance Health Equity Solutions. 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 0000009312 00000 n 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. Launched in August 2022 and expected to continue through the winter, the staffing study is comprised of four main parts: literature review, site visits, quantitative analyses, and cost analyses all further described below. 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. 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. 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. 0000008976 00000 n Sign up to get the latest information about your choice of CMS topics in your inbox. Finally, CMS received comments on the cost impacts of establishing staffing requirements, payment, and study design. "To care for them, you have to give them dignity. In addition, the current nursing shortage 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. Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. At least three states adopted permanent changes to staff training requirements to expand the pool of staff available to work in nursing homes post-COVID (Figure 2 and Appendix Table 3). 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. May provide direct care and be counted in direct care ratios. WebA skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. Before sharing sensitive information, make sure youre on a federal government site. If youre looking for a nursing staffing solution, look no further than NurseDash. While federal requirements state that facilities must maintain sufficient nursing staff to meet residents needs, specific guidelines are not set and state regulations vary drastically. Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. Skilled Nursing News is part of the Aging Media Network. Despite these existing requirements, understaffing continues to be a concern. 0000004038 00000 n Legislation that would have permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states. But those state-level requirements are all lower than what the federal government recommended more than two decades ago, the last time the issue was studied. 0000013059 00000 n In a statement provided to Skilled Nursing News, the state Department of Health said, at this time, nursing homes should appropriately document their efforts to comply with the law. 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. 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. When Jordyn's not covering the latest skilled nursing news, she's likely catching a Cubs game at Wrigley Field, cheering on the Iowa Hawkeyes or watching Gilmore Girls all the way through for the millionth time. Nominate Now. she asks. Sandri struggles to get certified nursing assistants, who typically start at $15.20 an hour, in the door. Senator Bob Casey Jr. outlining their concerns about a proposed federal staffing requirement by the Centers for Medicare and Medicaid Turnover at her facility, home to about 100 residents, is nearly triple what it was before the pandemic. 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 has announced plans to propose new federal minimum staffing adequacy regulations in the next year. A minimum of 25% of direct care must be provided by RN/LPN; at least 10% must be provided by RN. We also examine state legislative and regulatory actions since the onset of the pandemic that directly affect worker wages (other than increases to provider reimbursement rates), and training requirements. umw=@em;o~mvwnyes,>xyOmoK]q6rk^/B xc6@0 As passed by the House in November 2021, the Build Back Better provisions would have directed the HHS Secretary to study and report to Congress and propose regulations on any appropriate minimum federal nursing staff to resident ratios. 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. As part of the staffing study, quantitative analyses will be conducted to identify staffing levels associated with improved quality of care and resident safety in nursing homes. Federal government websites often end in .gov or .mil. Training: At least 3 states (KY, MO, WI) adopted permanent changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes, while at least 8 states (AK, CT, DE, IA, IN, KS, MO, WI) adopted temporary changes in this area. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022 In February, the Biden Administration announced a comprehensive set of reforms to 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 In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. "We think it's really important to set a very specific standard that can be measured against, to really make sure staff is adequate to ensure quality," says Chiquita Brooks-LaSure, administrator for the Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates and funds most nursing homes in the U.S. [6]What else is included in the study? But he is appealing to younger people to consider a job in a nursing home. 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. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. 1 Assistant DON RN/LPN full-time. "It was a daily struggle before COVID. 5376 (117th Congress) (2021-2022). One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. Facilities will be held accountable if they fail to meet this standard. We also examine state legislative and regulatory actions since the onset of the pandemic that directly affect worker wages and training requirements. As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. 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. We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. 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. And not one that runs smoothly. 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. 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. 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. NurseDash offers a variety of features to help nursing homes with their staffing needs, including: If youre looking for a nursing staffing solution, look no further than NurseDash. Nursing home administrators also opposed the bill due to an increasing statewide staffing shortage, which was exacerbated by the pandemic. However, there has never been a federally required minimum number of staffing hours per resident day, despite repeated calls to establish one from researchers and patient advocates over the last several decades. A goal of North Carolinas legislation is to raise staff wages to $15.00 per hour; prior to the increase, wages averaged $10.30 per hour. 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 Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. Commenters offered recommendations for implementing minimum staffing requirements. [10] See, e.g., CY 2022 Medicare Physician Fee Schedule, available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched. 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. 0000002445 00000 n Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK A decade after suffering a stroke that forever changed his life, Maurice Miller has good days and bad ones. 5 states with the highest-rated nursing homes. Weve heard directly from hospitals their frustration about not being able to discharge people who are not ready to return to the community, he said. Unless the government increases the amount it pays for nursing home care, Sandri says, "we just don't have it in our piggy bank. Eric Lee for NPR That resident may end up waiting in soiled bedclothes for a while. 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. The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident 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. 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. Key findings include the following: Staffing Requirements: At least five states (AR, CT, MA, NY, RI) adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least one state (GA) adopted a permanent decrease. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. 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. 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. Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). Job in Ashburn - VA Virginia - USA , 20146. 0000013130 00000 n 0000001884 00000 n If LPN is Charge Nurse, RN must be on call. Florida also amended its definition of direct care staff whose hours can count toward the minimum hprd to include personal care attendants. To meet the new staffing requirements, it would take an additional 5,610 additional staff for New York facilities, according to the report. Eric Lee for NPR For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. The bill was voted down two days later in the House Health and Family Services Committee. In In the midst of these continuing financial and staffing pressures, providers would be remiss if they did not also consider the existing and prospective regulatory requirements for minimum staffing levels. The law stipulates that 70% of a nursing homes revenue is to be spent on direct resident care and at least 40% spent on staffing. "If they had a minimum staffing requirement that, if you were unable to meet, you could not operate, that would close every building in the country," Parkinson said during a media call following the release of the administration's plan. Figure 2 summarizes state activity post-COVID in the areas of minimum staffing requirements, worker wages, and training requirements. as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. [7] CMS has historically posted facility staffing metrics on Nursing Home Care (now known as Care Compare), such as the average number of hours worked for nursing staff per resident per day. 0000000016 00000 n In conducting the cost-benefit analysis required for any rulemaking, including the staffing requirement, CMS must evaluate any associated incremental costs that facilities would likely face. 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 reimbursement reaches the current required rate ($94.11) plus its actual audited costs above that rate and the costs of increasing the staff-to-resident hours. While Congress could adopt legislative changes, it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation that passed the House would be included in a potential budget reconciliation package that could be considered this summer. 0000007128 00000 n hb```f``[ Abl,=`4T 9J9*/p.S5UY-C[4Yi`:HF0p n_/u]'uCnx|LOhk^mpvm\5[xkVOhgsWh*@ . Yet, a recent report concluded that staffing standards in almost every state remain severely low. In April 2022, the National Academies of Science, Engineering, and Medicine recommended minimum staffing levels, policies to ensure competitive wages and benefits, and improvements to staff training and opportunities for career advancement, among other reforms, as part of its comprehensive report to improve nursing home quality. 0000020352 00000 n At least three other states (IL, MA, and NC) adopted changes that require nursing homes to increase staff wages as a condition of receiving increased Medicaid provider reimbursement rates. Top Characteristics of a Successful Nursing Student and How to Improve Them, Ultimate Guide to Nursing School Must-Haves, Prioritizing Self-Care: A Guide for Nursing Students, 4 Great Takeaways From Our Latest Fireside Chat About College Financial Aid, Top Nursing Tips: How to Make 2023 Your Best Year Yet. The government has increased scrutiny and staffing requirements in response to COVID-19. A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. Before the law even went into effect, of the 611 nursing homes in the state 383 (63%) were considered below 3.5 hours per resident day staffing requirements. Additionally, Missouri now allows third parties to administer the certification test for nursing assistants, which is expected to expedite the process by six to eight weeks. Maurice Miller's call button is attached to his gown. Interviews with nursing home leadership, direct care staff (including RNs, LPNs/LVNs, and CNAs), and residents and their family members will be conducted to better understand the relationship between staffing levels, staffing mix (what types of staff are present), and resident outcomes and experiences (i.e., clinical outcomes, safety, health disparities) using rich contextual information collected during the interviews. Site visits to nursing homes and related analyses. 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. Additionally, the federal regulations include a qualitative standard, which requires nursing homes to provide sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident. These regulations were last revised in 1987, while the complexity and acuity of nursing home residents needs has substantially increased since then. Skilled Nursing News An official website of the United States government. 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. 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. Welcome to the Nursing Home Resource Center! Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing new nursing home minimum staffing requirements at a federal level. Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. To meet the nursing needs of all residents. While you await upcoming CMS guidance on minimum staffing requirements, you can always look to current nursing home staffing requirements by 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. 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. hide caption. 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. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. The Biden Administration recently announced plans to propose new federal minimum staffing adequacy regulations in the next year. WebNew Appraisal Review Requirements and Instructions Regarding Department of Veterans Affairs Appraisal Management Service for the Lender Appraisal Processing Program and The CLA report found that it would cost anywhere from $250,000 to $1.6 million in annual costs per facility that is below the newly imposed staffing requirements. 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. Andrea Hsu/NPR [1] https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/, [2] 87 FR 22720, pages 22771-22772: https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [3] Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule:https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [4] Social Security Act, sections 1819 and 1919, [5] Social Security Act, sections 1128I(g)(4), 1819, and 1919, [6] Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, 2001: https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf; and the 2005 Staff Time and Resource Intensity Verification (STRIVE) Project: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/TimeStudy. 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