The Biden administration announced on Monday that nursing homes will now be mandated to maintain a minimum number of front-line caregivers. Failure to meet these requirements could result in financial penalties for the facilities.
Despite strong opposition from bipartisan lawmakers and intense lobbying from the nursing home industry, Vice President Harris has unveiled the final policy. These lawmakers and industry representatives argue that implementing a federal standard is not feasible due to the nationwide staffing shortage, which has been exacerbated by the COVID-19 pandemic.
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The White House has implemented a rule to tackle the issue of chronically understaffed nursing homes, which often results in inadequate and unsafe care. According to a fact sheet released by the administration, these rules set a minimum requirement for staffing levels. However, it is expected that a significant number of the country’s approximately 15,000 nursing homes will have to hire additional staff in order to comply with the new standards.
In his 2022 State of the Union address, President Biden unveiled a series of reforms for nursing homes, with a promise to include staffing minimums. For over two decades, advocates have been advocating for this requirement, emphasizing that increased staff numbers contribute to the safety and improved care of residents.
The revised policy expands upon the initial proposal put forth by the administration in September. It now mandates that all nursing homes receiving federal funding from Medicare and Medicaid must ensure a minimum of 3.48 hours of nursing care per resident per day. This includes a requirement of three hours provided by registered nurses and nursing aides.
Facilities have the flexibility to utilize various combinations of nursing staff, including registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs), and nurse aides, in order to accommodate the extra time required.
According to the administration, a facility with 100 residents would now require two or three registered nurses and 10 or 11 nurse aides. Additionally, two extra nurse staff members per shift would be necessary to meet the new standards.
According to a crucial federal study conducted in 2001, it was found that the current hourly requirement falls below the recommended standard. The study suggests that facilities should provide a minimum of 4.1 hours of direct care per resident per day to ensure their safety from falls and other potential harms.
The final rule will also mandate that facilities must have a registered nurse available round the clock, 24 hours a day, seven days a week.
The staffing mandates are facing strong opposition from the nursing home industry.
Mark Parkinson, CEO of the American Health Care Association, expressed his dismay at the administration’s decision to finalize the rule, calling it “unconscionable” in light of the severe workforce shortages across the country.
Sen. Jon Tester (D-Mont.) reiterated his previous concerns about the staffing requirement, expressing doubts about its feasibility for rural nursing homes.
According to Senator Tester, long-term care facilities in Montana are currently dealing with a significant shortage of workforce, and seniors in rural areas are having difficulty accessing the necessary care. While the federal staffing mandate may have good intentions, Tester believes that it could potentially lead to the closure of facilities and does not effectively address the concerns raised by local providers and Montanans.
Other Democrats and advocates for consumers and nursing home residents, including unions, expressed a desire for the administration to enhance the requirements. While acknowledging that the rule was a step in the right direction, they believed that it fell short of being comprehensive enough.
“The Biden Administration has made some improvements to the new minimum nurse staffing standards,” said Rep. Lloyd Doggett (D-Texas), who led over 100 House members in a comment letter last year. He expressed his satisfaction that these changes offer a glimmer of hope for enhanced care and resident safety for vulnerable nursing home residents with complex medical needs. However, he emphasized that much more still needs to be done to ensure adequate care for these individuals.”
