The Biden administration is proposing a new minimum staffing standard for American nursing homes, and the move is receiving mixed feedback.
Those in favor argue that it will help to increase the quality of care in these facilities, while those who oppose the newly proposed standard argue that it could lead to nursing home closures and other unintended consequences.
Among its stipulations, the proposed rule would require nursing home facilities to have a registered nurse (RN) on staff 24 hours a day, seven days a week.
Current federal law mandates that nursing homes have an RN on duty for eight consecutive hours a day, seven days a week. It also requires that these facilities have a licensed nurse, who could be an RN or a licensed practical nurse, on staff at all times. In defense of its proposal, the Biden administration pointed to research that found that a 20-minute increase in RN staffing per day correlated to 22% fewer cases of COVID-19 and 26% fewer COVID-related deaths in nursing homes.
“Other studies similarly find that higher staffing is associated with better quality of patient care and patient health outcomes,” the administration stated in an online fact sheet announcing the proposed rule.
“In recent years, there has been a disturbing trend towards private equity firms and other large corporate owners purchasing nursing homes and slashing levels of staff as a way to maximize profits.” Meanwhile, roughly 100 House members sent a bipartisan letter to the Biden administration, urging it to reconsider and withdraw the proposed rule due to concerns that it could lead to unintended nursing home closures.
“At a time when nursing homes are already experiencing health care worker shortages and financial hardships, [the Centers for Medicare & Medicaid Services] and the Biden administration should not be implementing a regulation that would only exacerbate this issue,” said Rep. Greg Pence (R-Ind.), who was lead author of the letter.
“If implemented, facilities throughout the country will have no choice but to deny access to our nation’s seniors who need nursing home care, especially in rural communities, like many of the ones I represent in Indiana’s sixth congressional district. This one-size-fitsall regulatory requirement will result in many negative consequences.”
Looking at current staffing levels, a study by the Kaiser Family Foundation found that only 19% of U.S. nursing home facilities would be able to meet the newly proposed standards. The same study also found that 90% of for-profit facilities would need to hire more staff to meet the new minimum requirement, whereas 60% of nonprofit facilities would need to hire more RNs and/or nurse aides to meet the new staff minimums.
If the rule goes into effect, most nursing homes will have two years to meet the minimum staffing requirements, while rural nursing homes would have three years. Industry stakeholders also argued against a one-sizefits-all approach for nursing home staffing due to the possibility of overlooking unique needs at various facilities. In fact, some facilities may actually require even higher staffing needs than a federally approved industry minimum, and residents could get shortchanged. “It’s honestly heartbreaking,” Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit that advocates for nursing home patients in New York state, told NPR.
“I just don’t see how this doesn’t ultimately put more residents at risk of neglect and abuse. Putting the government’s imprimatur on a standard that is patently unsafe is going to make it much more difficult for surveyors to hold facilities accountable for the harm caused by understaffing nursing homes.” Other critics of the proposed staffing rule argue that it is difficult to find people willing to do these jobs as they are often low paying and taxing. “The workforce challenges are real,” Katie Smith Sloan, president and CEO of LeadingAge, an association that represents nonprofit nursing homes, told NPR.
In order to meet higher staffing requirements or needs, advocates argue that state Medicaid programs should increase payments to nonprofit facilities, and for-profit facilities could afford to put more money back into the cost of care. The proposed rule was announced in September and received nearly 50,000 comments before the public comment period closed in early November, indicating that debate about the issue of minimum nursing home staff will likely continue even if the proposed rule goes into effect as it is currently written.
For more background, see the April 2016 issue of Congressional Digest on “Obamacare Update.”
