[12] See, e.g., Criminal Indictment, U.S. v. Ryan Hee; and VDA OC, LLC, No. Michigan enacted a temporary one year increase of $2.35 per hour for direct care staff, including nurses and aides. This is an important body of work that will ensure nursing home residents are receiving the safe and quality care that they deserve. Once the state-declared public health emergency ends, these nurse aides are not required to complete additional training. WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK 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. At least three states (MI, NC, OH) adopted temporary increases or one-time bonuses to nursing home staff wages post-COVID. To maintain the highest practicable physical, mental, and psychological well-being of each resident. 0000013059 00000 n [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. 2.70 hprd; 1:20 ratio of nursing staff to residents; 2 staff on duty at all times, Texas (Austin, Dallas, Houston, San Antonio). This article briefly outlines a sample of such minimum staffing regulations, as specifically applied to nurses, and also offers some potential cost-effective ideas for maintaining a minimum level of required nursing staff. Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. 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). 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. Sufficient Numbers of all nursing staff to meet residents needs. "Are we using our dollars well? However, the current minimum thresholds for nursing home staffing may soon be changing. Job in Ashburn - VA Virginia - USA , 20146. Connecticut and Kansas adopted changes that allow temporary nurse aides to work, though Connecticuts temporary executive order has expired. 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. 1570 Grant Street. [2] State of the Long Term Care Industry: Survey of nursing home and assisted living providers show industry facing significant workforce crisis, American Health Care Association, National Center for Assisted Living (September 2021), available at https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf. Thats according to a report compiled by professional services firm CliftonLarsonAllen (CLA) as part of a partnership with the NYS Health Facilities Association. As the White House considers stricter federal staffing minimum requirements, regulations in some parts of the country are bowing to the realities of the skilled nursing industrys workforce crisis.. As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. [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. 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. 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 hide caption. 3 Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. 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. 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. The only resolution to the workforce crisis, which is not going to be resolved today, tomorrow, in a month, or six months for that matter, is a partnership between the administration, the legislature, providers and labor working together to put in real initiatives that will help recruit and retain workers, Hanse told Skilled Nursing News. Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. 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. In Or electronically to: Christine.Bates1@state.co.us. A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining North Carolinas legislature appropriated $1 million for one-time bonus payments to direct care staff, while Ohios legislature appropriated $300 million for wages, incentives, and bonuses to recruit and retain direct care staff. Belle Harris CMS is also conducting a stakeholder listening session on August 29, 2022 from 1-2:30 p.m. EST to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. How does new federal staffing requirements affect facilities? 0000007726 00000 n 5 states with the highest-rated nursing homes. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. In a 2001 report, CMS found that in order to avoid bad outcomes, nursing home residents should each receive at least 4.1 hours of direct nursing care per day. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. 1 Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. 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. [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. Holly Ward has worked as a geriatric nursing assistant at a nursing home in Baltimore for four years. Four out of 5 who initially express interest in a job don't come in for interviews. Federal government websites often end in .gov or .mil. 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. 7500 Security Boulevard, Baltimore, MD 21244. 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 Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. In some states, the minimum requirement is half the recommended level. 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. At least five states adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least one state adopted a permanent decrease (Figure 2 and Appendix Table 1). 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. hb```f``[ Abl,=`4T 9J9*/p.S5UY-C[4Yi`:HF0p n_/u]'uCnx|LOhk^mpvm\5[xkVOhgsWh*@ Additionally. KFF appreciates the contributions of Emma Childress, law/master of health administration student at St. Louis University, and Belle Harris, law student at Georgetown University, who worked as contractors on this project. 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. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. The mandate comes at a time when the Biden administration has set its sights on a federal nursing home staffing minimum. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. %PDF-1.7 % But he is appealing to younger people to consider a job in a nursing home. 0000006860 00000 n Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. The 1987 Nursing Home Reform Act, which brought sweeping changes to the industry, requires facilities to have "sufficient" staff so that residents can achieve or maintain their "highest practicable" physical, mental and psychosocial well-being. They're burned out. The Department of Social Services has made funding available to nursing homes to meet the staffing requirements. You can be a dog walker for $18 an hour," she says. 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. 0000006058 00000 n Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. 0000030078 00000 n In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. 0000006448 00000 n Maryland, where Ward works, actually does have a minimum staffing requirement for nursing homes, as do most states. In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. Eric Lee for NPR 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. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. 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. 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). This staffing study seeks to help identify a minimum staffing level, which would include RN, LPNs/LVNs, and CNAs, that will establish a threshold below which residents would be at substantially increased risk of not receiving the safe and quality care they deserve. Receive industry updates and breaking news from SNN. Create customized staffing solutions that fit your unique needs, which we know can change at any time. Facilities can post open shifts that result from job vacancies, sickness, vacations, or even an increase in minimum staffing requirements and nurses can choose the shifts that work best for them, in their desired location. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet nursing needs of [their] residents and must use the services of a registered professional nurse at least 8 consecutive hours a day, seven days a week. 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. 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. 2435 43 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. Additionally, observational data will be collected onsite using trained clinicians who will observe and record time spent on care provision, including taking care to differentiate time spent on care provision from time spent on administrative nursing. Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. President Bidens proposed Build Back Better bill, for example, would require the U.S. Department of Health and Human Services (HHS) to submit reports to Congress on the appropriateness of minimum staff to resident ratios in skilled nursing facilities,[4] signaling future potential minimum staffing ratios that might extend beyond the reach of COVID-19. Massachusetts and North Carolina both direct nursing homes to devote a certain share of the rate increase to direct care staff wages (75% and 80%, respectively). The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. Numerous studies have found that high staffing levels are associated with higher care quality. hA 04Pk\GczC. 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. Contact us now for staffing assistance. Published: May 16, 2022. Although setting minimum staffing requirements could have a positive impact on the overall quality of care and resident satisfaction, the financial impact could be devastating for some facilities. More recently, CMS uses the public Nursing Home Five Star Quality Rating System to identify facilities with staffing challenges, such as low weekend staffing or excess variation in daily staffing levels. 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. 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. Are they going to direct care?" Nominate a skilled nursing future leader who is raising the bar for patient care in homes & health care facilities across the country. Find nursing staff with a variety of specialties, including geriatric nursing, palliative care nursing, and more. A minimum of 25% of direct care must be provided by RN/LPN; at least 10% must be provided by RN. 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. States can choose to adopt staffing or training requirements that are stricter than federal rules as part of their role in licensing nursing home providers and administering state Medicaid programs, which finance the majority of nursing home care. Detailed state-level information is included in the Appendix Tables. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. Oregon and South Carolinas temporary decreases still result in state minimum staffing requirements that exceed the federal minimum level of 0.30 hprd. 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. Innovative talent drives the aging industry forward. Flexible pay and scheduling structures for nursing staff, including incentive pay, career development and training programs, and alternative benefits that do not increase base pay. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. In February 2022, President Biden announced a comprehensive set of reforms to improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed care choices. Nursing home administrators also opposed the bill due to an increasing statewide staffing shortage, which was exacerbated by the pandemic. While Medicare and Medicaid reimbursement rates to nursing homes can indirectly influence worker wages, states also can adopt policies to require or incentivize providers to raise wages paid to direct care workers. 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. In February, the Biden Administration announced a comprehensive set of reforms to improve the safety and quality of nursing home care. 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. The American Health Care Association, which represents 14,000 long-term care facilities, has called into question the administration's authority to enact such a rule without involving Congress. That is the main factor they stress at the job, yet you don't give us the staff to provide that," Ward says. 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 Responses are due on June 10, 2022. What did CMS learn from the Request for Information? 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. 98 (D. Nev) (Mar. 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. COVID-19 reporting requirements Screening Infection prevention Planning for staff shortages Staff exclusion Visitors to facilities Staffing and designating separate areas for residents with COVID-19 Testing Staff vaccination rule DHS Resources 211 Wisconsin Call 211 or 877-947-2211 to get referrals for thousands of services across By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. 0000002408 00000 n Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. 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. Based on the federal government's 5-star rating system for nursing homes from November 2022, Hawaii has the best average score (3.90 across 41 facilities), followed by Alaska (3.80, 20 facilities), Idaho (3.46, 78 facilities), Delaware (3.35, 43 facilities), and Utah (3.34, 96 facilities). MECHANICSBURG, Pa. (March 1, 2023) LeadingAge PA, an association representing more than 370 aging services providers, including many who operate nonprofit nursing homes, sent a letter to U.S. is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. At least eight states adopted temporary changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes (Appendix Table 3). Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. 0000034862 00000 n 0000035309 00000 n Numerous studies have shown that understaffing nursing homes can harm the health of residents, who suffer more bedsores, more weight loss, more overprescribing of anti-psychotic medications, and during the pandemic more COVID-19 cases and deaths. To meet the nursing needs of all residents. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. 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. levels. "You have an opportunity to turn this industry on its head. As of December 2021, only the District of Columbia met or exceeded the minimum of 4.1 hprd recommended to prevent harm to residents. The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Emma Childress , 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. 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. 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. A new law in New York state will require nursing homes to meet minimum standards for staffing and patient care. Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before 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). Site visits to nursing homes and related analyses. One after another. hide caption. 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. These changes apply to all staff and are not limited to providers that participate in Medicaid. [8], States have also recently increased scrutiny over minimum nurse staffing levels. 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. In a 2001 report, CMS found that in order to avoid bad outcomes, nursing home residents should each receive at least 4.1 hours of direct nursing care per day. . 0000031792 00000 n (Nov. 22, 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. To residents n Maryland, where Ward works, actually does have a minimum of 4.1 hprd recommended prevent. 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