Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022 In February, the Biden Administration announced a comprehensive set of reforms to "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. Senator Bob Casey Jr. outlining their concerns about a proposed federal staffing requirement by the Centers for Medicare and Medicaid Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. While staffing shortages in nursing homes have existed for decades, the COVID-19 pandemic has highlighted and intensified the need for sufficient, consistent, trained staff to care for residents. 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. In some states, the minimum requirement is half the recommended level. 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. Denver, CO 80203. 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. To maintain the highest practicable physical, mental, and psychological well-being of each resident. A December 2021 study found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. May provide direct care and be counted in direct care ratios. However, the bill was voted down in the House Rules Committee four days later. [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. "So it becomes like an assembly line," Ward says. 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. Detailed state-level information is included in the Appendix Tables. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. Figure 2 summarizes state activity post-COVID in the areas of minimum staffing requirements, worker wages, and training requirements. Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). 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. The Biden Administration recently announced plans to propose new federal minimum staffing adequacy regulations in the next year. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, 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. 0000004038 00000 n 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. How does new federal staffing requirements affect facilities? 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. To attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. 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 Cannot go below 1:40 RN/LPN ratio. 2.5 hprd for intermediate care, 3.8 hprd for skilled nursing care. 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. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. hide caption. 0000013130 00000 n ". [1] Tim Regan, 81% of Assisted Living Providers Report Recent Staff Shortages, Senior Housing News (June 23, 2021), available at https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Access a large database of nursing staff, making it easy to find the perfect match for your needs. Or electronically to: Christine.Bates1@state.co.us. 0000002445 00000 n The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. Yet, a recent report concluded that staffing standards in almost every state remain severely low. In April 2022, the National Academies of Science, Engineering, and Medicine recommended minimum staffing levels, policies to ensure competitive wages and benefits, and improvements to staff training and opportunities for career advancement, among other reforms, as part of its comprehensive report to improve nursing home quality. Alaskas temporary reduction applies during any state-declared public health emergency, not just during the COVID public health emergency. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. Certified Nurse Aides 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. Top Characteristics of a Successful Nursing Student and How to Improve Them, Ultimate Guide to Nursing School Must-Haves, Prioritizing Self-Care: A Guide for Nursing Students, 4 Great Takeaways From Our Latest Fireside Chat About College Financial Aid, Top Nursing Tips: How to Make 2023 Your Best Year Yet. 0000023002 00000 n Get the latest information, guidance, clarification, instructions, and recent COVID-related policies, Find the latest resources and guidance for people in nursing home and their caregivers, See more on the Providers & CMS Partners page, See more on the Patients & Caregivers page. as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. 0000002408 00000 n Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. Federal regulations require nursing homes to provide licensed nursing services 24 hours a day, with a registered nurse on staff for at least eight consecutive hours a day, seven days a week. 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. levels. Read on to learn more about the new nursing home minimum staffing requirements and the effect they could have on facilities. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. [6]What else is included in the study? Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. 0000031451 00000 n Andrew Cuomo in 2021 as a way to improve nursing home transparency and hold bad actors accountable. 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. [6], Furthermore, CMS has increased its reporting requirements for nursing homes, public posting of facility staffing measures, and enforcement penalties for nursing homes that do not comply with staffing requirements. [11]. Opens in a new window. The bill was voted down two days later in the House Health and Family Services Committee. Following up on the White House announcement of a package of nursing home reforms, CMS recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. 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. Numerous studies over several decades have found that high staffing levels are associated with higher care quality for nursing home residents. Gov. 26, 2021); Ltr. All rights reserved. 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. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. 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. Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. 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. 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. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. At least 1.1 hours of care must be given by a registered nurse (RN) or licensed practical nurse (LPN). April 20, 2023 Washington, D.C. 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. And not one that runs smoothly. The Biden Administration has announced plans to propose new federal minimum staffing adequacy regulations in the next year. 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. 7500 Security Boulevard, Baltimore, MD 21244. Hochuls move received mixed reactions from labor unions and industry trade groups. 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. Monday Friday: 9am-5pm, New Nursing Home Minimum Staffing Requirements By State for 2023, New federal staffing requirements may be coming. 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. In response to the COVID-19 public health emergency, CMS temporarily waived the training requirement as a means of addressing potential staffing shortages during the pandemic. Maurice Miller's call button is attached to his gown. Four out of 5 who initially express interest in a job don't come in for interviews. Before the law even went into effect, of the 611 nursing homes in the state 383 (63%) were considered below 3.5 hours per resident day staffing requirements. 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. To meet the needs of the residents in an appropriate and timely manner. Belle Harris In a statement provided to Skilled Nursing News, the state Department of Health said, at this time, nursing homes should appropriately document their efforts to comply with the law. CMS currently posts staffing data for all facilities on the Care Compare website, including resident census data and data on the hours of care provided per resident per day. 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. CMS currently posts staffing data for all facilities on the Care Compare website, including resident census data and data on the hours of care provided per resident per day. "You have an opportunity to turn this industry on its head. Providers in states from Virginia to New York are pushing back on the requirements they say threaten their ability to provide the best care 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. 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. These changes apply to all staff and are not limited to providers that participate in Medicaid. Bradley attorneys can assist with the full spectrum of healthcare regulatory and employment matters, or with any other matter that arises in the long-term care space. Are they going to direct care?" 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. Facilities will be held accountable if they fail to meet this standard. "To care for them, you have to give them dignity. 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. 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, as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. Increased adoption of automatic technologies or administrative processes such as patient intake, consent management, payment processing, and appointment scheduling, to reduce staff workload. 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. 1 DON RN full-time or minimum 36 hrs/wk (at least 18 hrs between 7am and 7pm). Strengthen staffing, testing and infection control measures at long-term care facilities; and Keep stakeholders informed about the impact of COVID-19 on long-term The only place that has adopted the federal government's guidance of 4.1 hours of care per day is Washington, D.C. "We think about meeting the numbers every single day," says Tina Sandri, CEO of Forest Hills of DC. 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. 0000030078 00000 n 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. Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. 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. She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. 0000009312 00000 n We include both permanent and temporary changes to illustrate the types of action states are taking. 0000034507 00000 n In April 2022, the National Academies of Science, Engineering and Medicine recommended minimum staffing levels, policies to ensure competitive wages and benefits, and improvements to staff training and opportunities for career advancement, among other reforms, as part of its comprehensive report to improve nursing home quality. Commenters offered recommendations for implementing minimum staffing requirements. What are the next steps and how can I get involved? We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. 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. Home Blog New Nursing Home Minimum Staffing Requirements By State for 2023. Site visits to nursing homes and related analyses. The pandemic has taken a substantial toll on people living and working in nursing homes. For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. Additionally. Turnover at her facility, home to about 100 residents, is nearly triple what it was before the pandemic. 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. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. The reforms include minimum staffing requirements and other changes for which resident advocates have long fought. Job While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. "In D.C., you can work for Amazon at $19 an hour. At least three states adopted temporary wage increases or one-time bonuses for nursing home staff post-COVID. [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. A December 2021 study reviewed state nursing home staffing standards and concluded that staffing standards in almost every state remain severely low. The Medicaid and CHIP Payment and Access Commission (MACPAC) recently reviewed state policies that can help address staffing issues, including increasing Medicaid payment rates, changing Medicaid payment methods to incentivize facilities to devote more revenue to staff, and requiring minimum staffing levels above the federal standard. 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. 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. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet 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. 0000009595 00000 n Published: May 16, 2022. 5 states with the highest-rated nursing homes. 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. "They're tired. [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). 1 Assistant DON RN/LPN full-time. 0000029962 00000 n 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). An official website of the United States government. Or when he misses his wheelchair time because there aren't enough staff to lift him out of bed. The White House on Monday unveiled a slew A new law in New York state will require nursing homes to meet minimum standards for staffing and patient care. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. Detailed state-level information is included in the Appendix Tables. [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. Its president, Mark Parkinson, has also argued that such a requirement is "unrealistic" and "not possible" because nursing homes can't find workers. 7500 Security Boulevard, Baltimore, MD 21244, By:Pauline Karikari-Martin PhD, MPH, MSN, PHNA-BC, RN Senior Nurse Researcher and Cameron Ingram, MFA Policy Analyst of the Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services Staffing Study to Inform Minimum Staffing Requirements for Nursing Homes, In February 2022, President Biden announced a, 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. If DON has institutional responsibilities, add 1 Assistant DON RN full-time. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. 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. . NurseDash is an on-demand healthcare marketplace that connects facilities with staffing needs to clinicians looking for open nursing shifts. umw=@em;o~mvwnyes,>xyOmoK]q6rk^/B xc6@0 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 WebState Minimum Staffing Standard for Licensed Nursing Homes Staffing Standard Converted to hprd for 100-Bed Facility Staffing Standard Citation and Hyperlink AK 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. 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. 0000031792 00000 n You can be a dog walker for $18 an hour," she says. Support Team is Available 24/7 "And then it's on your conscience.". As of December 2021, only the District of Columbia met or exceeded the minimum of 4.1 hprd recommended to prevent harm to residents. By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. They're burned out. 0000013059 00000 n Following up on the White House announcement of a package of nursing home reforms, the Centers for Medicare and Medicaid Services (CMS) recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. In the midst of these continuing financial and staffing pressures, providers would be remiss if they did not also consider the existing and prospective regulatory requirements for minimum staffing levels. An official website of the United States government. Despite these existing requirements, understaffing continues to be a concern. 1 DON RN full-time (8 hours, between 6am6pm). 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. These states include Oregon and South Carolina. Four of these states (AK, DE, IN, and WI) lowered the training hour requirements for CNAs during the pandemic, in efforts to address staffing issues. NurseDash is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. For open nursing shifts in facilities next year if they fail to meet this standard or practical... Assistant DON RN full-time 1 Assistant DON RN full-time, minimum 36 hours, between 6am6pm.. Most of its funding entire shifts without receiving toileting assistance, leading to falls or increased of. 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