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. Or when his roommate is having a crisis of some sort and help does not come immediately. 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). 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. 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. Innovative talent drives the aging industry forward. According to Genworths 2018 Cost of Care Survey, assisted Site visits to nursing homes and related analyses. Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. 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. 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. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. Holly Ward has worked as a geriatric nursing assistant at a nursing home in Baltimore for four years. Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. 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. 0000007275 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. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. 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. An official website of the United States government. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA. The law requires every facility to maintain daily staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide, licensed practical nurse or registered nurse. What are the next steps and how can I get involved? 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. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. Oregon and South Carolinas temporary decreases still result in state minimum staffing requirements that exceed the federal minimum level of 0.30 hprd. 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. Andrew Cuomo in 2021 as a way to improve nursing home transparency and hold bad actors accountable. [8], States have also recently increased scrutiny over minimum nurse staffing levels. levels. hide caption. "They're tired. Four out of 5 who initially express interest in a job don't come in for interviews. . In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. 1 DON RN full-time. [6]What else is included in the study? 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. 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 White House on Monday unveiled a slew 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. 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. 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. Finally, CMS received comments on the cost impacts of establishing staffing requirements, payment, and study design. To attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. To meet the needs of the residents in an appropriate and timely manner. [10] See, e.g., CY 2022 Medicare Physician Fee Schedule, available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched. 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. [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. The bill was voted down two days later in the House Health and Family Services Committee. 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 What did CMS learn from the Request for Information? Published: May 16, 2022. Receive industry updates and breaking news from SNN. Ease your staffing struggles with NurseDash! Over the next year, policy action is expected on the federal level related to nursing home staffing. 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. 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. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. Filling the need for trusted information on national health issues, MaryBeth Musumeci , 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. Welcome to the Nursing Home Resource Center! 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. 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. This equates to 0.30 staffing hours per resident day (hprd).3 Facilities also must designate a full-time registered nurse as a full-time director of nursing. 1570 Grant Street. However, the bill was voted down in the House Rules Committee four days later. At least three states adopted temporary wage increases or one-time bonuses for nursing home staff post-COVID. 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. Once the state-declared public health emergency ends, these nurse aides are not required to complete additional training. 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. Thats according to a report compiled by professional services firm CliftonLarsonAllen (CLA) as part of a partnership with the NYS Health Facilities Association. "Are we using our dollars well? 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. Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. 1 DON RN full-time (8 hours, between 6am6pm). 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. Skilled nursing facilities provide round-the-clock assistance with healthcare and activities of daily living. 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. Also, you can decide how often you want to get updates. 0000007304 00000 n Gov. 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 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. Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. 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. Or when he misses his wheelchair time because there aren't enough staff to lift him out of bed. 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. The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. Taking advantage of governmental funding for additional clinicians, such as the American Rescue Plans National Health Service Corps and Nurse Corps. found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. Cannot go below 1:40 RN/LPN ratio. 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. 2.5 hprd for intermediate care, 3.8 hprd for skilled nursing care. [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. 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. WebNursing homes must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. 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. 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. Providers in states from Virginia to New York are pushing back on the requirements they say threaten their ability to provide the best care By using NurseDash to hire your short-term nurses, you not only wont be paying overtime to your employees, but youll also benefit from fewer fees than standard staffing agencies. 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. hide caption. [11]. Federal law authorizes the Health and Human Services (HHS) Secretary to establish requirements relating to nursing home residents health, safety and well-being as conditions for facilities to receive payment from the Medicare and Medicaid programs. 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. Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. Arizona introduced HB 2848 on February 11, 2021, which would have increased its minimum staffing requirement. 0000054667 00000 n Here, you'll find our nursing home resources, including COVID-19 public health emergency response information. 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. 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. 0000006860 00000 n "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. 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. [7] CMS has historically posted facility staffing metrics on Nursing Home Care (now known as Care Compare), such as the average number of hours worked for nursing staff per resident per day. Listed on 2023-03-01. Sandri struggles to get certified nursing assistants, who typically start at $15.20 an hour, in the door. If DON has institutional responsibilities, add 1 Assistant DON RN full-time. She's opposed to a federal minimum staffing requirement, noting that the government already has the ability to cite nursing homes for insufficient staffing. 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. The study team is currently reviewing existing literature to summarize the evidence of the relationship between minimum staffing in nursing homes and the safety and quality of care, as well as clarify the relative strengths and weaknesses of the available literature. 0000013130 00000 n 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. And not one that runs smoothly. Sign up to get the latest information about your choice of CMS topics in your inbox. The law was first introduced by former Gov. Still, on some shifts, she has as many as 13 residents to dress, feed, clean, change, move. The federal government does already have some staffing requirements in place for example, each facility must have a registered nurse on duty for eight hours per day but the core language is vague. MECHANICSBURG, Pa. (March 1, 2023) LeadingAge PA, an association representing more than 370 aging services providers, including many who operate Read on to learn more about the new nursing home minimum staffing requirements and the effect they could have on facilities. Federal regulations require nursing aides to complete a 75-hour training program and to pass a competency evaluation in order to work in a nursing home longer than four months. What did CMS learn from the Request for Information? 0000004472 00000 n To maintain the highest practicable physical, mental, and psychological well-being of each resident. 0000005687 00000 n While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. These data will enable the development of a simulation model to examine the impact of different staffing levels and patient acuity levels on the quality and timeliness of care. LEARN MORE, SPONSORED BY: 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. 0000002105 00000 n Commenters offered recommendations for implementing minimum staffing requirements. [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. 0000009595 00000 n Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022 In February, the Biden Administration announced a comprehensive set of reforms to 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. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. 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. "So it becomes like an assembly line," Ward says. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. 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. 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 Eric Lee for NPR The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. A goal of North Carolinas legislation is to raise staff wages to $15.00 per hour; prior to the increase, wages averaged $10.30 per hour. 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. Illinois specified that nursing homes must increase direct care staff wages by $1.00 per hour as of July 2020, and an additional 50 cents per hour as of January 2021. 0000001178 00000 n Emma Childress , and This brief examines state legislative and regulatory actions since the onset of the pandemic to address nursing home staffing, including minimum staffing requirements, policies that directly affect worker wages (other than increases to provider reimbursement rates), and training requirements. 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]. 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. Access a large database of nursing staff, making it easy to find the perfect match for your needs. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. 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. 0000031136 00000 n As of March 20, 2022, nursing homes were most likely to report a shortage of aides, followed by nursing staff, and least likely to report a shortage of clinical staff. The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirement confirmation. 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