2435 43 The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 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. "You have an opportunity to save my life," he says. Maryland, where Ward works, actually does have a minimum staffing requirement for nursing homes, as do most states. 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. WebStaffing rates by state Overall, nursing facility staffing rates vary widely across states (Figure 1). Its president, Mark Parkinson, has also argued that such a requirement is "unrealistic" and "not possible" because nursing homes can't find workers. They're physically exhausted, and even committed people in this industry will turn around and say, 'I don't know how much longer I can do this,'" says Sandri. It's also a bad day when he cannot call his 94-year-old mother, because his computer has been pushed out of reach. 0000035945 00000 n The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that 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. Alaskas temporary reduction applies during any state-declared public health emergency, not just during the COVID public health emergency. Holly Ward has worked as a geriatric nursing assistant at a nursing home in Baltimore for four years. 0000034507 00000 n 0000020352 00000 n 0000030078 00000 n Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. 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. 98 (D. Nev) (Mar. 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. Others recommended that minimum staffing levels be established for residents with the lowest care needs, assessed using the MDS 3.0 assessment forms, citing concerns that acuity-based minimums will be more susceptible to gaming. 0000012942 00000 n 1 Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. If employers actually invest and agree that they are going to do everything they can to retain those committed workers, they wont lose them, she said during a virtual news conference on Friday. 0000007304 00000 n 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). 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. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. 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 also examine state legislative and regulatory actions since the onset of the pandemic that directly affect worker wages and training requirements. 0000002408 00000 n Or electronically to: Christine.Bates1@state.co.us. Home Blog New Nursing Home Minimum Staffing Requirements By State for 2023. 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). Read on to learn more about the new nursing home minimum staffing requirements and the effect they could have on facilities. Are they going to direct care?" 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. 0000006448 00000 n Legislation that would have permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states. An official website of the United States government. Support Team is Available 24/7 Additionally. Sufficient Numbers of all nursing staff to meet residents needs. Also, you can decide how often you want to get updates. 1 DON RN full-time (8 hours, between 6am6pm). 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. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. 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. 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. CMS should immediately implement requirements for 24/7 registered nurse staffing and a full-time social worker in all nursing homes. Arizona introduced HB 2848 on February 11, 2021, which would have increased its minimum staffing requirement. 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. Specifically, Florida retained its total hprd but increased the number of licensed practical nurse hours and decreased the number of certified nursing assistant hours that count toward the overall total. 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. 0000035309 00000 n 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. "They're tired. 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. While you await upcoming CMS guidance on minimum staffing requirements, you can always look to current nursing home staffing requirements by 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. 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. Welcome to the Nursing Home Resource Center! Stephen Hanse, New York State Health Facilities Association president and CEO, said the laws do not reflect the current reality of New Yorks long-term care landscape, calling it unworkable.. Unless the government increases the amount it pays for nursing home care, Sandri says, "we just don't have it in our piggy bank. It means that you have to confront issues around wages, issues around benefits, issues around working conditions and what it means to have a safe working environment for the caregivers.. Gov. "We think it's really important to set a very specific standard that can be measured against, to really make sure staff is adequate to ensure quality," says Chiquita Brooks-LaSure, administrator for the Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates and funds most nursing homes in the U.S. Ease your staffing struggles with NurseDash! Emma Childress , and 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. Detailed state-level information is included in the Appendix Tables. 0000002445 00000 n Detailed state-level information is included in the Appendix Tables. It is even more so now.". 0000034862 00000 n Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. 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. 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. May provide direct care and be counted in direct care ratios. Before sharing sensitive information, make sure youre on a federal government site. 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. 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). Filling the need for trusted information on national health issues, MaryBeth Musumeci , 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. The new federal staffing requirements would likely increase costs for nursing homes, which could lead to even more closures and cutbacksultimately making it even more difficult for seniors to get the care they need. 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. To meet the needs of the residents in an appropriate and timely manner. 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. 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. April 20, 2023 Washington, D.C. 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. 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. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. ATTN: Christine Bates. Gov. hide caption. 1 DON RN full-time. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. They're burned out. . 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. 0000013130 00000 n ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. Monday Friday: 9am-5pm, New Nursing Home Minimum Staffing Requirements By State for 2023, New federal staffing requirements may be coming. 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. 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. 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. In Virginia, House Bill 646 would require the state Board of Health to establish a minimum of 2.8 hours direct care per resident per day for nursing aide staff, and at Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. Opens in a new window. 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. 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. [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/, https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched, https://leadingage.org/sites/default/files/LeadingAge%20Letter%20to%20FTC%20-%20staffing%20agencies%20final%2010-8.pdf, Buying Distressed Operations in the Skilled Nursing Facility Space, Distressed Long Term Care Assets: A Lenders Perspective, Regulatory Considerations in Acquisitions of Troubled Long Term Care Facilities, CCPA/CPRA & VCDPA Notice of Collection, Disclosure, & Privacy Policy, Minimum Staffing Requirements for Nursing Homes Pose Regulatory Risks, Increased use of telehealth and telemedicine technologies, especially in light of CMS expanded reimbursement for such services.[10]. 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