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New Federal Standards Proposed for Minimum Nursing Home Staff

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October 9, 2023 •  Emily Hicks Law, PLLC
The Centers for Medicare & Medicaid Service (CMS) is aiming to give families more peace of mind by proposing new mandatory nursing home rules.

The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for overseeing Medicare and Medicaid programs, has unveiled a set of groundbreaking mandatory minimum staffing standards for nursing homes. This development aims to address the critical issue of staffing in long-term care facilities, with a focus on improving the quality of care for residents. Under the proposed rule, nursing homes across the nation will be given a grace period of three years to achieve compliance with these new staffing requirements.

The key aspect of these proposed standards is the requirement that nursing homes must provide a minimum of three hours of patient care per day, which includes hours provided by a registered nurse. This requirement is a significant shift towards enhancing the level of care and attention residents receive. Additionally, rural facilities will be granted extended timelines to meet these staffing criteria, acknowledging the unique challenges they face in recruiting and retaining qualified staff.

One striking aspect of the proposed rule is the inclusion of 24/7 registered nurse coverage, a substantial increase from the current requirement of only eight hours per day, seven days a week. This heightened presence of registered nurses is expected to elevate the quality of care provided and enhance the safety of residents.

It's worth noting that the proposed three hours of daily patient care falls short of the recommended four hours per day, as previously endorsed by a CMS study. Nonetheless, this proposal marks a significant step forward, given that a staggering 75% of nursing homes currently fall short of the suggested staffing levels. Implementing these requirements would necessitate many facilities to recruit and hire additional staff. While consumer advocacy groups and the disability community have long advocated for higher staffing standards, especially in light of the challenges posed by the COVID-19 pandemic, the nursing home industry has been vehemently opposing these changes. They argue that even meeting their existing staffing needs is a formidable task, particularly when it comes to hiring Elder Care nurses. Industry representatives anticipate that they will not be able to return to pre-pandemic staffing levels until 2027.

Another noteworthy provision in the proposed rule is the mandate for facilities to disclose how they allocate Medicaid payments. This requirement includes revealing the percentage of Medicaid funds that go towards compensating direct care workers. This transparency measure aims to ensure that public funds are used efficiently and that a substantial portion is directed towards improving the quality of care and adequately compensating the caregiving workforce.

These new staffing standards represent a significant departure from the staff-to-resident ratios enacted in New Jersey in 2020. They underscore the urgency of addressing staffing and financial challenges faced by nursing homes and emphasize the importance of developing alternative care options, such as home- and community-based services, to meet the evolving needs of our aging population. This move towards higher standards in nursing home staffing signals a commitment to improving the lives and well-being of the residents who rely on these facilities for their care and support.

Reference: "The National Law Review" (October 5, 2023) New Federal Standards Proposed for Minimum Nursing Home Staff

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