New Nursing Home Staffing Rules Attempt to Enhance Nursing Home Care Amid Ongoing Concerns

The Centers for Medicare & Medicaid Services (CMS) finalized a new rule to improve care quality and safety for millions of nursing home residents. The rule's centerpiece focuses on ensuring facilities have enough qualified staff to provide proper care.

Under the new ruling, nursing homes must significantly increase staffing levels. Facilities must provide a minimum of 3.48 hours of direct nursing care per resident daily. This translates to at least 55 minutes of daily care from a registered nurse (RN) and an additional 2.45 hours from a qualified nurse aide (NA).

CMS Administrator Chiquita Brooks-LaSure says these new minimum staffing standards are a significant step forward in ensuring nursing home residents receive the care they deserve.

For too long, understaffing has been a persistent concern, and this rule sets a clear national baseline to improve resident safety and well-being.

Many Depend on Medicaid for Long-Term Care

In the United States, a significant number of people rely on Medicaid for nursing home care. According to the most recent data from the Kaiser Family Foundation, approximately 1.4 million people used Medicaid to cover institutional long-term care services in 2020.

Medicare (and traditional health insurance) will only pay for short-term skilled services. Medicaid will pay for long-term care services for those with limited financial resources.

Long-Term Care Insurance will pay for comprehensive long-term care services, including in-home care, but due to medical underwriting, policies must be purchased when someone has fairly good health. However, most long-term care is delivered outside of nursing homes.

RN on Duty 24/7: Enhanced Oversight

A key rule provision mandates that a registered nurse be available at the facility around the clock. This rule ensures a qualified medical professional is always on-site to address resident needs, especially during evenings, nights, and weekends when emergencies or complications may arise. This measure seeks to enhance the quality of care and ensure immediate medical attention is available whenever needed.

CMS Phases in New Staffing Requirements for Nursing Homes

Understanding the potential challenges facilities may face in meeting these new requirements immediately, the Centers for Medicare & Medicaid Services (CMS) is implementing the staffing increases in phases. Non-rural facilities will have three years to fully comply, while rural facilities will have an additional two years to adjust. This phased approach allows nursing homes time to hire additional staff and adapt their operations. This strategy aims to ensure that all facilities can meet the new standards without compromising the quality of care for residents during the transition period.

Enhancing Transparency in Medicaid Funding for Nursing Homes

The regulations also introduce measures to increase transparency in Medicaid funding for nursing homes. States must now report how much Medicaid money is explicitly allocated towards staffing, including nurses and aides.

This transparency ensures better oversight, ensuring that public funds are effectively used to improve the quality of resident care. By exposing funding allocations, this provision aims to hold facilities accountable and enhance the overall standard of care.

Challenges and Solutions: A Multifaceted Approach

While the new staffing requirements are a significant step forward, the issue of nursing home staffing shortages remains complex. CMS acknowledges this challenge and is taking additional steps to address it.

The agency has announced a $75 million national nursing home staffing campaign to increase the number of nurses working in nursing homes through financial incentives for recruitment and streamlined training programs for nurse aides.

The Road Ahead: Monitoring and Potential Adjustments

CMS will closely monitor the impact of the new ruling. The agency will review data and feedback over the next few years to determine if further adjustments are necessary.

Brooks-LaSure says that CMS is committed to ensuring this rule leads to meaningful improvements in resident care.

We will be closely monitoring the implementation and use the data to make sure these new standards are effectively improving the lives of our nation's nursing home residents.

Industry Concerns and Opposition

Some industry groups representing nursing homes have criticized the new staffing rule. The leading industry association, the American Health Care Association (AHCA/NCAL), issued a statement expressing "extreme disappointment" with the final rule. They argue that the staffing requirements are unrealistic and will lead to facility closures, particularly in rural areas already facing workforce shortages.

• Key Concerns from Industry Groups: Difficulty finding qualified staff: AHCA/NCAL argues there aren't enough nurses and aides available to meet the new staffing requirements, especially in rural areas. They claim this could force some facilities to close, ultimately limiting access to care for seniors.

• Increased Costs: Industry groups argue the rule will lead to significant cost increases for nursing homes. They say these costs will be passed on to residents and Medicaid programs.

• Focus on Quantity over Quality:  Some critics argue the rule prioritizes staffing levels over resident needs and qualifications. They suggest a more nuanced approach considering resident acuity and individual care plans.

Medicaid Reimbursement Rates Low

Most surveys suggest that people desire quality long-term care services for anyone we care about. The AP-NORC Center for Public Affairs Research showed that the majority of respondents (age 40 and older) believed it's important to have high-quality care available when needed. However, quality care can be costly, and Medicaid reimbursement rates are low. Medicaid is the primary payer of long-term care for low-income adults and reimburses facilities at lower rates than private insurance.

These low reimbursement rates can place nursing homes in a difficult position. Many experts say that in order to stay afloat financially, facilities may struggle to hire enough qualified staff, potentially impacting the quality of care residents receive and the amount of time staff can dedicate to each patient.

Federal mandates will add additional pressure on these facilities. Several organizations, including industry groups representing nursing homes, patient advocacy groups, and labor unions, are pushing for higher Medicaid reimbursement rates. They argue that current rates are insufficient to cover the cost of providing quality care and are a barrier to attracting and retaining qualified staff.

However, increasing Medicaid reimbursement rates requires additional government funding, which can be a tough sell in a time of competing budget priorities.

For those with savings, experts suggest planning, including Long-Term Care Insurance, to prevent spending down personal savings and thus qualifying for Medicaid.