[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 law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. 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. But he is appealing to younger people to consider a job in a nursing home. Innovative talent drives the aging industry forward. 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. Home Blog New Nursing Home Minimum Staffing Requirements By State for 2023. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. 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. The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. Increased adoption of automatic technologies or administrative processes such as patient intake, consent management, payment processing, and appointment scheduling, to reduce staff workload. 0000035796 00000 n [5] Some States may also have minimum staffing requirements for nursing homes. 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. In addition, the current nursing shortage 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. 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. 0000030078 00000 n Sign up to get the latest information about your choice of CMS topics in your inbox. Although South Carolinas state agency did not explicitly describe the reasons for the temporary change, South Carolina hospitals are experiencing similar difficulty discharging patients to nursing homes due to staffing shortages. 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. All of the states adopting permanent minimum staffing changes post-COVID, including Georgia with its decrease, continue to exceed the federal minimum staffing requirement of 0.30 hours per resident day. 0000009312 00000 n Nursing homes across the state of New York must now abide by a new law that requires facilities to meet minimum staffing levels after Gov. Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. What will the staffing study look like? Alaskas temporary reduction applies during any state-declared public health emergency, not just during the COVID public health emergency. Compared to the federal minimum of 0.30 hprd, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum. This simulation model is important to ensure that the staffing study reflects not just what staffing levels exist currently as a descriptive model, but also what staffing levels are needed for safe, quality care for patients at varying acuity levels. 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. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. 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. You can be a dog walker for $18 an hour," she says. 2435 0 obj <> endobj xref Oregon adopted this temporary change in response to difficulties hospitals encountered in trying to discharge patients to nursing homes; staffing shortages were the primary reason that nursing homes declined to accept new residents. The Department recently made major changes to the state nursing home regulations. "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. Are they going to direct care?" This effort includes issuing a Request for Information (which occurred earlier this year as a part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. Are there federal nursing home staffing standards currently in place? Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. This effort includes issuing a Request for Information (which occurred earlier this year as a part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule[3]) and conducting a new study. hide caption. 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. 2.5 hprd for intermediate care, 3.8 hprd for skilled nursing care. Maurice Miller's call button is attached to his gown. On bad days, something goes wrong and it takes awhile before someone is available to respond to his call button sometimes 45 minutes or longer. [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. Wages: At least four states (CO, IL, MA, NC) adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic. She aims to have a rule in place within a year, an optimistic time frame given the lengthy federal rulemaking process and other challenges. [6]What else is included in the study? Some states explicitly require a minimum number of staff hours per resident day, while other states call for nursing homes to provide direct care staff 24 hours per day, seven days per week, without an explicit number of hours per resident requirement. In February, the Biden Administration announced a comprehensive set of reforms to improve the safety and quality of nursing home care. 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. 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. More information and the registration link for the event is available here: https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9. 0000031792 00000 n "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. What did CMS learn from the Request for Information? ATTN: Christine Bates. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. He hears about it from the staff, who apologize for the long waits and ask for patience. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. 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 We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. 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. 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. 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). Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. Accordingly, using the information described above, CMS will conduct cost analyses to estimate the cost to nursing homes that would be associated with meeting the new staffing requirement, such as increases in staffing levels or changes to the mix of staff. 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. Author(s) Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. Gov. 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. 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. Often, to meet the basic needs of every resident, Ward says she ends up skipping other important components of their care, such as talking with them and providing emotional support. "They look to you for comfort, but then when you don't have time to adequately give them the comfort they deserve, it's not fair," says Ward. 0000006860 00000 n 0000031136 00000 n 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. Michigan enacted a temporary one year increase of $2.35 per hour for direct care staff, including nurses and aides. 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. "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. 0000007275 00000 n 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. 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 0000035945 00000 n In addition to analyses of the relationship between staffing and safe and quality care, CMS will also conduct descriptive analyses of staffing levels, examining trends in nursing home staffing from 2018-2021 and identifying specific factors that are related to staffing levels. 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. The government has increased scrutiny and staffing requirements in response to COVID-19. Nursing home staff shortages and high turnover rates among staff are largely attributed to low wages. 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. 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. 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. [8], States have also recently increased scrutiny over minimum nurse staffing levels. At least two states (OR, SC) adopted temporary decreases to account for potential staffing issues during the pandemic. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022 In February, the Biden Administration announced a comprehensive set of reforms to 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. Fines for noncompliance could be up to $2,000 a day, she said. Listing for: ProMedica Senior Care. hide caption. Maryland, where Ward works, actually does have a minimum staffing requirement for nursing homes, as do most states. In addition to administrative agency action, Congress could adopt legislative changes, though it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation would be included in another budget reconciliation package that is possible this summer. 0000035697 00000 n Site visits to nursing homes and related analyses. 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. [10] See, e.g., CY 2022 Medicare Physician Fee Schedule, available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched. 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. Additionally. The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, 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. Training: At least 3 states (KY, MO, WI) adopted permanent changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes, while at least 8 states (AK, CT, DE, IA, IN, KS, MO, WI) adopted temporary changes in this area. [12] Going forward, providers would be well-served to keep in mind these and any other regulatory staffing requirements. 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. Andrea Hsu/NPR [7] Nursing Home Staff Turnover and Weekend Staffing Levels, Memorandum from CMS to CMS Certified Nursing Home Operators (Jan. 7, 2022). Or when his roommate is having a crisis of some sort and help does not come immediately. WebThe Manager of an ALR must: Be at least 21 years old Have experience in administration, supervision, and management Have a Bachelor's degree or equivalent experience in human services management, housing management, or nursing home management The Manager must be of good moral character and must never have been convicted of a felony. 0000006448 00000 n Janus Pan, As the nation continues to open back up in the wake of COVID-19, individual communities and providers continue to face significant staffing shortages and financial pressures. "Are we using our dollars well? 7500 Security Boulevard, Baltimore, MD 21244. 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. Skilled Nursing News is part of the Aging Media Network. 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. It is even more so now.". The mandate comes at a time when the Biden administration has set its sights on a federal nursing home staffing minimum. 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. "To care for them, you have to give them dignity. May provide direct care and be counted in direct care ratios. 0000035309 00000 n Skilled nursing facilities provide round-the-clock assistance with healthcare and activities of daily living. Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before [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. 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. 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. 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. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA. 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. 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. CMS has advised states to reevaluate their training programs and consider allowing some of the time worked by nursing aides during the public health emergency to count toward the 75-hour training requirement after the waiver ends. 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. Acuity of nursing home Ammula, KFF research assistant requesting confirmation of receipt, if applications are submitted electronically provide. 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