For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. 0000005687 00000 n The contracted researchers are conducting site visits to 75 nursing homes throughout the country. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before May provide direct care and be counted in direct care ratios. 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. Create customized staffing solutions that fit your unique needs, which we know can change at any time. 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. Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. 0000004511 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. 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 0000004472 00000 n 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. On some days, she has as many as 13 residents to care for on a shift. Other states adopting increases include Arkansas, Massachusetts, and New York. Belle Harris 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. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, 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. 0000035697 00000 n Why hold facilities to a number when there aren't people to fill the jobs? [2] State of the Long Term Care Industry: Survey of nursing home and assisted living providers show industry facing significant workforce crisis, American Health Care Association, National Center for Assisted Living (September 2021), available at https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf. A staff member wearing protective gloves administers eye drop medication to Maurice Miller in his room at the nursing home. However, CMS recently announced that this waiver will sunset on June 6, 2022, citing concerns about care quality. 0000055058 00000 n Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. WebStaffing rates by state Overall, nursing facility staffing rates vary widely across states (Figure 1). 0000035796 00000 n There is substantial variation in state minimum staffing requirements (Figure 1). Detailed state-level information is included in the Appendix Tables. "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. she asks. Webduring the 2021 session in section 10 of Public Act 21-185 regarding minimum staffing level requirements for nursing homes. Maurice Miller's call button is attached to his gown. umw=@em;o~mvwnyes,>xyOmoK]q6rk^/B xc6@0 Of the 3.5 hours, no less than 2.2 hours of care must 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 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. 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. Increased adoption of automatic technologies or administrative processes such as patient intake, consent management, payment processing, and appointment scheduling, to reduce staff workload. Denver, CO 80203. 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. 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. Two years into the pandemic, he says it's time for them to take care of themselves. At least three states (MI, NC, OH) adopted temporary increases or one-time bonuses to nursing home staff wages post-COVID. 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. 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. Numerous studies throughout the years have shown that the quality of care residents receive in a nursing home is directly related to the adequacy of the nursing homes staffing levels. 0000008084 00000 n 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. As of December 2021, only the District of Columbia met or exceeded the minimum of 4.1 hprd recommended to prevent harm to residents. 1 DON RN full-time (8 hours, between 6am6pm). [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. 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. 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. CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. However, the current minimum thresholds for nursing home staffing may soon be changing. That resident may end up waiting in soiled bedclothes for a while. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. 0000020352 00000 n 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. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. [9] Senate Bill 6346 (State of New York) (2021). CMS administrator Brooks-LaSure says she's listening to industry concerns, including their call for more money to keep up with rising costs, especially labor. 2435 0 obj <> endobj xref "So it becomes like an assembly line," Ward says. 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. Emma Childress , and 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). 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. The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. But he is appealing to younger people to consider a job in a nursing home. By contrast, Georgia permanently decreased its minimum staffing requirement by 0.24 hprd. SPONSORED BY: We include both permanent and temporary changes to illustrate the types of action states are taking. Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). 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. 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. 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. 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. The government has increased scrutiny and staffing requirements in response to COVID-19. 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. 0000002408 00000 n 0000036022 00000 n The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. Skilled Nursing News 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. 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 key initiative within the Presidents strategy is to establish a new minimum staffing requirement. And not one that runs smoothly. Find nursing staff with a variety of specialties, including geriatric nursing, palliative care nursing, and more. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. ". The pandemic has taken a substantial toll on people living and working 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 0000013059 00000 n 0000007726 00000 n Before sharing sensitive information, make sure youre on a federal government site. A June 2021 Senior Housing News article reported that 81% of assisted living providers suffer from staffing shortages. What did CMS learn from the Request for Information? 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. At least eight states adopted temporary changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes (Appendix Table 3). 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. The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that 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. Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. It is even more so now.". 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. 0000002105 00000 n 0000054667 00000 n Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet 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. 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. 0000001884 00000 n These changes apply to all staff and are not limited to providers that participate in Medicaid. Also, you can decide how often you want to get updates. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 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. Andrea Hsu/NPR Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 hA 04Pk\GczC. 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. 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. Over 200,000 residents and staff in long-term care facilities have died from COVID-19, comprising more than one in five of all COVID-19 deaths in the U.S.1 Most of these deaths (about 155,000) have occurred in nursing homes that are certified to participate in the Medicare and/or Medicaid programs.2. 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. One of these states, Wisconsin, lowered the training hour requirement for nurse aides from 120 hours to the federal minimum of 75 hours. Contact us now for staffing assistance. [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. Specifically, that report notes the need to improve worker wages, benefits, training, and working conditions as an integral part of improving nursing home resident health and quality of life. 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). [1] https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/, [2] 87 FR 22720, pages 22771-22772: https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [3] Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule:https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, [4] Social Security Act, sections 1819 and 1919, [5] Social Security Act, sections 1128I(g)(4), 1819, and 1919, [6] Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, 2001: https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf; and the 2005 Staff Time and Resource Intensity Verification (STRIVE) Project: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/TimeStudy. 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