Current Federal Staffing Requirements: Sufficient Numbers of all nursing staff to meet residents needs. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that 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. 0000009312 00000 n 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. "It's so that each person gets exactly what they need to be the best they can be and live their best life," says Robyn Grant, director of public policy and advocacy at the Consumer Voice, a group focused on long-term care. 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. 0000007128 00000 n as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. 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. 5376 (117th Congress) (2021-2022). 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. An official website of the United States government. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. 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. The reforms include minimum staffing requirements and other changes for which resident advocates have long fought. 0000034862 00000 n Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. [7] Nursing Home Staff Turnover and Weekend Staffing Levels, Memorandum from CMS to CMS Certified Nursing Home Operators (Jan. 7, 2022). The federal government does already have some staffing requirements in place for example, each facility must have a registered nurse on duty for eight hours per day but the core language is vague. The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. Kathy Hochul lifted a three-month pause on Friday. 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. Sign up to get the latest information about your choice of CMS topics in your inbox. While there are a variety of opinions among stakeholders on establishing minimum staffing requirements, it is CMS goal to consider all perspectives, as well as findings from the staffing study. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. Cannot go below 1:40 RN/LPN ratio. 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. 0000036022 00000 n 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 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. 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. hb```f``[ Abl,=`4T 9J9*/p.S5UY-C[4Yi`:HF0p n_/u]'uCnx|LOhk^mpvm\5[xkVOhgsWh*@ Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. "It was a daily struggle before COVID. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. Contact us now for staffing assistance. Must have 1 RN who is full-time DON (5 days/wk); if fewer than 60 residents, DON may also be Charge Nurse. [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. 2435 0 obj <> endobj xref Facilities will be held accountable if they fail to meet this standard. In January 2022, CMS began posting data on the level of weekend resident nurses, total nurse staffing, and staff turnover for all nursing homes on the Care Compare website. Other states adopting increases include Arkansas, Massachusetts, and New York. 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. 0000004038 00000 n By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. 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. 0000008976 00000 n Monday Friday: 9am-5pm, New Nursing Home Minimum Staffing Requirements By State for 2023, New federal staffing requirements may be coming. 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. "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. It is even more so now.". Arkansas also adopted a broader definition of the direct care staff whose hours count toward its new minimum staffing requirement, while Rhode Island no longer allows director of nursing hours to count toward its new minimum staffing requirement. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet Still, on some shifts, she has as many as 13 residents to dress, feed, clean, change, move. [12] See, e.g., Criminal Indictment, U.S. v. Ryan Hee; and VDA OC, LLC, No. To maintain the highest practicable physical, mental, and psychological well-being of each resident. Also, you can decide how often you want to get updates. For that reason, CMS believes it essential to patient safety that it conduct the new rulemaking to establish more specific, detailed, and quantitative minimum staffing requirements. 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. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. Federal government websites often end in .gov or .mil. 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. 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. Specifically, Florida retained its total hprd but increased the number of licensed practical nurse hours and decreased the number of certified nursing assistant hours that count toward the overall total. [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. 26, 2021); Ltr. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. There are several strategies providers and nursing facilities may consider to comply with the governments increasingly-stringent staffing requirements: Additionally, the government has been cracking down on excessively high costs charged by nurse staffing agencies, which could help providers maintain cost-effectiveness as they continue wrestling with these staffing challenges. The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident It also states that nursing home operators in the state are required to return all profits in excess of 5% to the state, regardless of the quality of care or whether the operator sustained losses in prior years. In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. Once the state-declared public health emergency ends, these nurse aides are not required to complete additional training. [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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