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. 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. "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. 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. [5] Some States may also have minimum staffing requirements for nursing homes. 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. 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 Missouri also established reciprocity standards to allow out-of-state certified nursing assistants (CNAs) to work in Missouri. 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. 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. Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. Other states adopting increases include Arkansas, Massachusetts, and New York. New Jersey retained its total hprd but now divides the daily minimum to set specific hprd requirements during each of the three shifts in a day. The bill was voted down two days later in the House Health and Family Services Committee. 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). Detailed state-level information is included in the Appendix Tables. 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. May provide direct care and be counted in direct care ratios. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. Stephen Hanse, New York State Health Facilities Association president and CEO, said the laws do not reflect the current reality of New Yorks long-term care landscape, calling it unworkable.. 0000008490 00000 n Monday Friday: 9am-5pm, New Nursing Home Minimum Staffing Requirements By State for 2023, New federal staffing requirements may be coming. 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. Eric Lee for NPR More information and the registration link for the event is available here: https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9. The bad days are more likely to be those when the facility is short-staffed. 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. "In D.C., you can work for Amazon at $19 an hour. Commenters offered recommendations for implementing minimum staffing requirements. 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. Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. In Takoma Park, Maurice Miller doesn't blame the staff who have left his facility in recent weeks for other jobs. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. However, the bill was voted down in the House Rules Committee four days later. MECHANICSBURG, Pa. (March 1, 2023) LeadingAge PA, an association representing more than 370 aging services providers, including many who operate 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. Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. Numerous studies have found that high staffing levels are associated with higher care quality. [12] See, e.g., Criminal Indictment, U.S. v. Ryan Hee; and VDA OC, LLC, No. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. 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. It is even more so now.". 0000001178 00000 n 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. Ease your staffing struggles with NurseDash! . In determining what 24-hour services provide sufficient staffmeaning registered nurses (RNs), licensed practical and vocational nurses (LPNs and LVNs), and certified nurse aides (CNAs)facilities must account for individual resident assessments and plans of care, in addition to the facility assessment. As a nonprofit, Forest Hills of DC doesn't have the bandwidth to raise wages, Sandri says. 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. 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. Thats according to a report compiled by professional services firm CliftonLarsonAllen (CLA) as part of a partnership with the NYS Health Facilities Association. "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. 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. Additionally. [1] A September 2021 survey by the American Health Care Association and the National Center for Assisted Living showed that 86% of nursing homes and 77% of assisted living providers said their workforce situation has gotten worse over the three months preceding the survey. 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. 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. trailer <<3372BD4A84514E1EA1C61D098F46AB0E>]/Prev 308187/XRefStm 1884>> startxref 0 %%EOF 2477 0 obj <>stream 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. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. The Centers for Medicare and Medicaid Services (CMS) announced in November 2021 increased oversight of nursing services pursuant to 42 CFR 483.35, which mandates sufficient nursing staff at facilities receiving Medicare reimbursement: The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facilitys resident population in accordance with the facility assessment required at 483.70(e).[5], Specifically, CMS will survey nursing homes in the future for nurse competency, inappropriate use of antipsychotic medications, and other areas of residents health and concern. [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. New York State Health Facilities Association. Taking advantage of governmental funding for additional clinicians, such as the American Rescue Plans National Health Service Corps and Nurse Corps. 0000001884 00000 n What did CMS learn from the Request for Information? [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). The public comment period closed on June 10, 2022, and CMS received over 3,000. comments from a variety of interested parties including advocacy groups; long-term care ombudsmen; industry associations (providers); labor unions and organizations; nursing home staff and administrators; industry experts and other researchers; family members, and caretakers of nursing home residents. 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 Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. 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. 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. 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. 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. 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. 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. The Biden Administration has announced plans to propose new federal minimum staffing adequacy regulations in the next year. CMS should immediately implement requirements for 24/7 registered nurse staffing and a full-time social worker in all nursing homes. A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. You can be a dog walker for $18 an hour," she says. 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. 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. 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. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA. 0000002105 00000 n 0000034862 00000 n Geriatric Nursing Assistant - GNA. In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. 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. 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. [4] Additionally, regulations specify that nursing homes are required to conduct an annual facility assessment, which considers resident needs and staff ability to provide care. 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. Its president, Mark Parkinson, has also argued that such a requirement is "unrealistic" and "not possible" because nursing homes can't find workers. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. 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. (Nov. 22, 2021). "What has been so ambiguous and subjective is how 'sufficient' is interpreted.". 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. Eric Lee for NPR 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. While the staffing requirements may be changing, here are the current staffing guidelines, according to the State Nursing Home Staffing Standards Summary Report for the markets supported by NurseDash. Illinois specified that nursing homes must increase direct care staff wages by $1.00 per hour as of July 2020, and an additional 50 cents per hour as of January 2021. WebThe monthly median cost of assisted living in Virginia is $4,451, which is higher than the national average of $4,000. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. DON may be Charge Nurse; 1 RN 8 consecutive hrs/7d/wk; 1 RN/LPN Charge Nurse; 24 hrs/7d/wk; 0.4 hprd RN/LPN or 1:20 RN/LPN every 24 hrs (Exclude administrative time of licensed staff and DON in a multi-level facility). The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 What will the staffing study look like? 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. 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. As a result, nursing homes have been able to determine what sufficient nursing staff means on their own, which has led to wide variations in nursing home staffing across the countryand as a result, wide variations in the level of care and safety of residents. "1ARPeBJU& lL" L@7, H XY~ B Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. 0000036022 00000 n Helen Schaub, the unions policy and legislative director, said during the virtual news conference that the health department will view payroll based journal (PBJ) data to ensure nursing homes are complying with the laws. The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. 0000005687 00000 n hb```f``[ Abl,=`4T 9J9*/p.S5UY-C[4Yi`:HF0p n_/u]'uCnx|LOhk^mpvm\5[xkVOhgsWh*@ Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. 2.5 hprd for intermediate care, 3.8 hprd for skilled nursing care. ". Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. Once the state-declared public health emergency ends, these nurse aides are not required to complete additional training. Must have 1 RN who is full-time DON (5 days/wk); if fewer than 60 residents, DON may also be Charge Nurse. Nursing home administrators also opposed the bill due to an increasing statewide staffing shortage, which was exacerbated by the pandemic. He hears about it from the staff, who apologize for the long waits and ask for patience. 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]. "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. 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. Oregon also authorized facilities to utilize personal care assistants, nursing assistants, physical therapists, and occupational therapists to meet no more than 25 percent of the certified nursing assistant minimum staffing requirement during this time. Receive industry updates and breaking news from SNN. 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. 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. Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. 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 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. The feedback received has and will be used to inform the research study design and proposals for minimum direct care staffing requirements in nursing homes in 2023 rulemaking. In 29 states, including Maryland, the minimum staffing requirement is 3.5 hours or less, according to an analysis by the Consumer Voice. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. Detailed state-level information is included in the Appendix Tables. Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). 0000007726 00000 n A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. As of March 27, 2022, more than one in four nursing homes nationally reported a shortage of at least one type of staff, though the share of nursing homes reporting staffing shortages varies widely by state. Fines for noncompliance could be up to $2,000 a day, she said. 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. Denver, CO 80203. 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). 0000054667 00000 n [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. 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. Support Team is Available 24/7 Senator Bob Casey Jr. outlining their concerns about a proposed federal staffing requirement by the Centers for Medicare and Medicaid 0000031451 00000 n 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. 26, 2021); Ltr. "To care for them, you have to give them dignity. Of the 3.5 hours, no less than 2.2 hours of care must hide caption. 0000030078 00000 n Andrew Cuomo in 2021 as a way to improve nursing home transparency and hold bad actors accountable. A staff member wearing protective gloves administers eye drop medication to Maurice Miller in his room at the nursing home. The law was first introduced by former Gov. Initial visits to 50 out of the 75 nursing homes will provide important information to guide the development of the proposed minimum staffing standards, and visits to the remaining 25 facilities will help validate the initial findings as part of CMSs iterative policy process. 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. 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. 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). Over the next year, policy action is expected on the federal level related to nursing home staffing. Turnover at her facility, home to about 100 residents, is nearly triple what it was before the pandemic. A decade after suffering a stroke that forever changed his life, Maurice Miller has good days and bad ones. 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. [2] The COVID-19 Public Health Emergency (PHE) has highlighted and exacerbated the long-standing staffing challenges experienced in many facilities, creating an urgent need to address this issue for the well-being of all individuals residing in our nations federally certified nursing homes and the workers who care for them. $ 12.00 per hour of $ 4,000 states may also have minimum staffing requirements for nursing homes to 3.5. Required to complete additional training 4.1 nursing hours per resident per day to prevent harm to.. 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