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. Before sharing sensitive information, make sure youre on a federal government site. 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. 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. 5376 (117th Congress) (2021-2022). That resident may end up waiting in soiled bedclothes for a while. Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. 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. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. 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. Filling the need for trusted information on national health issues, MaryBeth Musumeci , 26, 2021); Ltr. Holly Ward has worked as a geriatric nursing assistant at a nursing home in Baltimore for four years. 0000009312 00000 n 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 Takoma Park, Maurice Miller doesn't blame the staff who have left his facility in recent weeks for other jobs. Ease your staffing struggles with NurseDash! Others pointed to the variability of the various states Medicaid labor reimbursement and suggested that Medicaid rates in many states do not keep pace with rising labor costs. 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. 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. That is the main factor they stress at the job, yet you don't give us the staff to provide that," Ward says. 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. [2] In the same survey, more than 7 out of 10 long term care facilities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff.[3]. Key findings include the following: Staffing Requirements: At least five states (AR, CT, MA, NY, RI) adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least one state (GA) adopted a permanent decrease. At least three states adopted temporary wage increases or one-time bonuses for nursing home staff post-COVID. On some days, she has as many as 13 residents to care for on a shift. 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. 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. Mitigating factors can be considered by the [d]epartment when assessing penalties for non-compliance at a later date., 1199SEIU United Healthcare Workers East, Centers for Medicare & Medicaid Services, CliftonLarsonAllen, CMS, New York State Health Facilities Association. 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. Lying in bed in his darkened room, Miller usually knows when there are fewer than five nursing assistants tending to the 50 or so residents on his hall. Missouri also established reciprocity standards to allow out-of-state certified nursing assistants (CNAs) to work in Missouri. [9] Senate Bill 6346 (State of New York) (2021). Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. On good days, the staff at his nursing home in Takoma Park, Md., can meet all of his basic needs: feeding him, cleaning him, changing his hospital gown, and ensuring that his laptop, which he uses through dictation, is charged and within reach. [10] See, e.g., CY 2022 Medicare Physician Fee Schedule, available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched. 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. Or electronically to: Christine.Bates1@state.co.us. Providers in states from Virginia to New York are pushing back on the requirements they say threaten their ability to provide the best care 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. He hears about it from the staff, who apologize for the long waits and ask for patience. 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 meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". WebA skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. 0000008976 00000 n 0000006058 00000 n WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 9 STATE STANDARD State The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. April 20, 2023 Washington, D.C. 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. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. 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. [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). umw=@em;o~mvwnyes,>xyOmoK]q6rk^/B xc6@0 hide caption. 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. In 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. 1 DON RN full-time. But he is appealing to younger people to consider a job in a nursing home. The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident Published February 15, 2022 at 8:25 AM EST iStock / The Florida Channel In addition to the 2.5-hour standard, current law also requires that certified nursing assistants and licensed nurses provide a weekly average of 3.6 hours of direct care per patient per day. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. 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. 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 As a nonprofit, Forest Hills of DC doesn't have the bandwidth to raise wages, Sandri says. 2435 0 obj <> endobj xref Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. Michigan enacted a temporary one year increase of $2.35 per hour for direct care staff, including nurses and aides. Eric Lee for NPR "So it becomes like an assembly line," Ward says. Or when his roommate is having a crisis of some sort and help does not come immediately. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. [8], States have also recently increased scrutiny over minimum nurse staffing levels. 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. As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. But those state-level requirements are all lower than what the federal government recommended more than two decades ago, the last time the issue was studied. LEARN MORE, SPONSORED BY: 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. 1 DON RN full-time or minimum 36 hrs/wk (at least 18 hrs between 7am and 7pm). 0000023002 00000 n In determining what 24-hour services provide sufficient staffmeaning registered nurses (RNs), licensed practical and vocational nurses (LPNs and LVNs), and certified nurse aides (CNAs)facilities must account for individual resident assessments and plans of care, in addition to the facility assessment. 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. Two years into the pandemic, he says it's time for them to take care of themselves. 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. 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. [12] Going forward, providers would be well-served to keep in mind these and any other regulatory staffing requirements. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. "You have an opportunity to save my life," he says. 0000001884 00000 n Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. If DON has institutional responsibilities, add 1 Assistant DON RN full-time. Still, on some shifts, she has as many as 13 residents to dress, feed, clean, change, move. A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. Advocacy groups also had staffing shortage concerns, but observed that, in their view, staffing has always been a challenge and emphasized that while additional efforts are needed to bolster the workforce, it should not deter CMS from setting minimum staffing levels in nursing homes. [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 mandate comes at a time when the Biden administration has set its sights on a federal nursing home staffing minimum. "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. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. 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. Weve heard directly from hospitals their frustration about not being able to discharge people who are not ready to return to the community, he said. As an example, New York proposed a bill to establish nursing home staffing levels, such as 3.5 hours of total nursing care per resident per day, with 1.1 hours of care being required from a licensed nurse.[9]. Contact us now for staffing assistance. 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. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. NurseDash is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. 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. Two states, Florida and New Jersey, retained their total daily minimum staffing hours but restructured how those hours are allocated across staffing types or shifts post-COVID (Appendix Table 1). New York State Health Facilities Association. For example, the U.S. Department of Justice and the Federal Trade Commission have recently increased enforcement against staffing agencies that price-fix nursing wages, as well as against nursing personnel agencies who engage in price gouging or unfair competition. WebApplications can be submitted to: Department of Health Care Policy & Financing. 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. 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. We encourage any interested party to register early for this event as there will be a maximum limit of 3,000 participants. The government has increased scrutiny and staffing requirements in response to COVID-19. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. 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. . 0000007128 00000 n While Congress could adopt legislative changes, it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation that passed the House would be included in a potential budget reconciliation package that could be considered this summer. 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). These changes apply to all staff and are not limited to providers that participate in Medicaid. Detailed state-level information is included in the Appendix Tables. 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. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. "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. 5 states with the highest-rated nursing homes. Some commenters suggested that CMS focus on implementing an acuity staffing model per shift instead of a minimum staffing requirement, while some recommended a staff to patient ratio instead. 0000008490 00000 n State Actions to Address Nursing Home Staffing During COVID-19, most likely to report a shortage of aides, staffing standards in almost every state remain severely low, must designate a full-time registered nurse as a full-time director of nursing, sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum, require a minimum number of staff hours per resident day, he primary reason that nursing homes declined to accept new residents, experiencing similar difficulty discharging patients to nursing homes due to staffing shortages, unpopular among nursing home industry representatives. 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. Other commenters representing advocacy groups stated that resident acuity should be a primary determinant in establishing minimum staffing standards, noting that Medicare pays nursing homes based on resident acuity level. Email, requesting confirmation of receipt, if applications are submitted electronically care residents receive help not. Staff, including nurses and aides this study is on an accelerated timeline and seeks to build on, replace... The quality of care per resident per day to prevent harm to residents date during the RFI process looks! 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