1 DON RN full-time. 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. This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. As the White House considers stricter federal staffing minimum requirements, regulations in some parts of the country are bowing to the realities of the skilled nursing industrys workforce crisis.. 0000013130 00000 n When pushed, a light goes on in his room, above his door, and at the nurses' station at his nursing home in Takoma Park, Md. 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. 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. While Medicare and Medicaid reimbursement rates to nursing homes can indirectly influence worker wages, states also can adopt policies to require or incentivize providers to raise wages paid to direct care workers. 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. 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. At least three states adopted permanent changes to staff training requirements to expand the pool of staff available to work in nursing homes post-COVID (Figure 2 and Appendix Table 3). umw=@em;o~mvwnyes,>xyOmoK]q6rk^/B xc6@0 Or when he misses his wheelchair time because there aren't enough staff to lift him out of bed. ATTN: Christine Bates. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. Helen Schaub, the unions policy and legislative director, said during the virtual news conference that the health department will view payroll based journal (PBJ) data to ensure nursing homes are complying with the laws. Following up on the White House announcement of a package of nursing home reforms, CMS recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. Responses are due on June 10, 2022. 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. Author(s) Numerous studies over several decades have found that high staffing levels are associated with higher care quality for nursing home residents. These states include Oregon and South Carolina. 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. The reforms include minimum staffing requirements and other changes for which resident advocates have long fought. If DON has institutional responsibilities, add 1 Assistant DON RN full-time. Andrew Cuomo in 2021 as a way to improve nursing home transparency and hold bad actors accountable. What will the staffing study look like? Finally, both federal and state policymakers will likely be considering the recommendations in the National Academies comprehensive report on improving nursing home care quality. . [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. What did CMS learn from the Request for Information? Also, you can decide how often you want to get updates. Receive industry updates and breaking news from SNN. Of the 3.5 hours, no less than 2.2 hours of care must be provided by a certified nursing assistant (CNA) or nurse aide. The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that reflects resident census, acuity, case mix and residents professional nursing needs as determined by their assessments and care plans. What did CMS learn from the Request for Information? "You have an opportunity to save my life," he says. Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. 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. The bill was voted down two days later in the House Health and Family Services Committee. 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. [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. The feedback received has and will be used to inform the research study design and proposals for minimum direct care staffing requirements in nursing homes in 2023 rulemaking. However, the bill was voted down in the House Rules Committee four days later. 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. Among the states that adopted increases, the amount ranged from an additional 0.16 hprd in Connecticut to an additional 3.78 hprd in Rhode Island. To meet the needs of the residents in an appropriate and timely manner. State Actions to Address Nursing Home Staffing During COVID-19, most likely to report a shortage of aides, staffing standards in almost every state remain severely low, must designate a full-time registered nurse as a full-time director of nursing, sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum, require a minimum number of staff hours per resident day, he primary reason that nursing homes declined to accept new residents, experiencing similar difficulty discharging patients to nursing homes due to staffing shortages, unpopular among nursing home industry representatives. It's also a bad day when he cannot call his 94-year-old mother, because his computer has been pushed out of reach. 0000030078 00000 n Often, to meet the basic needs of every resident, Ward says she ends up skipping other important components of their care, such as talking with them and providing emotional support. 0000002105 00000 n 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. 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. Andrea Hsu/NPR 98 (D. Nev) (Mar. Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. LEARN MORE, SPONSORED BY: Please provide a separate email, requesting confirmation of receipt, if applications are submitted electronically. Insufficient nursing home staffing levels are associated with negative outcomes for residents including increased rates of hospitalization, dehydration, weight loss, and pressure ulcers. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. 0000004511 00000 n 1 DON RN full-time (8 hours, between 6am6pm). Based on the federal government's 5-star rating system for nursing homes from November 2022, Hawaii has the best average score (3.90 across 41 facilities), followed by Alaska (3.80, 20 facilities), Idaho (3.46, 78 facilities), Delaware (3.35, 43 facilities), and Utah (3.34, 96 facilities). 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. 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). Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. This simulation model is important to ensure that the staffing study reflects not just what staffing levels exist currently as a descriptive model, but also what staffing levels are needed for safe, quality care for patients at varying acuity levels. The feedback received has and will be used to inform the research study design and proposals for minimum direct care staffing requirements in nursing homes in 2023 rulemaking. The mandate comes at a time when the Biden administration has set its sights on a federal nursing home staffing minimum. Facilities will be held accountable if they fail to meet this standard. Nursing home staff shortages and high turnover rates among staff are largely attributed to low wages. Must have 1 RN who is full-time DON (5 days/wk); if fewer than 60 residents, DON may also be Charge Nurse. "And then it's on your conscience.". 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. Turnover at her facility, home to about 100 residents, is nearly triple what it was before the pandemic. As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. Over the next year, policy action is expected on the federal level related to nursing home staffing. Before sharing sensitive information, make sure youre on a federal government site. 0000031792 00000 n The CLA report found that it would cost anywhere from $250,000 to $1.6 million in annual costs per facility that is below the newly imposed staffing requirements. In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. 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. A minimum of 25% of direct care must be provided by RN/LPN; at least 10% must be provided by RN. Site visits to nursing homes and related analyses. CMS is also conducting a stakeholder listening session on August 29, 2022 from 1-2:30 p.m. EST to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. [12] See, e.g., Criminal Indictment, U.S. v. Ryan Hee; and VDA OC, LLC, No. Florida also amended its definition of direct care staff whose hours can count toward the minimum hprd to include personal care attendants. In Takoma Park, Maurice Miller doesn't blame the staff who have left his facility in recent weeks for other jobs. [7] Nursing Home Staff Turnover and Weekend Staffing Levels, Memorandum from CMS to CMS Certified Nursing Home Operators (Jan. 7, 2022). Ward will find that while she's attending to one resident, another is incontinent. The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, 2.70 hprd; 1:20 ratio of nursing staff to residents; 2 staff on duty at all times, Texas (Austin, Dallas, Houston, San Antonio). 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. April 20, 2023 Washington, D.C. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. This issue brief summarizes federal and state standards related to nursing home staffing prior to COVID-19 and builds on existing information by identifying changes to state minimum staffing requirements adopted since the onset of the COVID-19 pandemic. A decade after suffering a stroke that forever changed his life, Maurice Miller has good days and bad ones. 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. One of these states, Wisconsin, lowered the training hour requirement for nurse aides from 120 hours to the federal minimum of 75 hours. "They look to you for comfort, but then when you don't have time to adequately give them the comfort they deserve, it's not fair," says Ward. 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. CMS also plans to conduct a research study, noting that resident acuity has increased in recent years, and to issue proposed regulations within one year. Awarded Best of Staffing - Talent 2022 and rated as a Top Workplace 2022 by the Orlando Sentinel, Jackson Nurse Professionals connects today's travel nurse to 0000007304 00000 n Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. 0000031136 00000 n 0000035796 00000 n Eric Lee for NPR 1 DON RN full-time or minimum 36 hrs/wk (at least 18 hrs between 7am and 7pm). Connecticut and Kansas adopted changes that allow temporary nurse aides to work, though Connecticuts temporary executive order has expired. Listed on 2023-03-01. 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. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. 0000029962 00000 n The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident Certified Nurse Aides 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. 7500 Security Boulevard, Baltimore, MD 21244. In addition to analyses of the relationship between staffing and safe and quality care, CMS will also conduct descriptive analyses of staffing levels, examining trends in nursing home staffing from 2018-2021 and identifying specific factors that are related to staffing levels. 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. 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. Hochuls move received mixed reactions from labor unions and industry trade groups. Create customized staffing solutions that fit your unique needs, which we know can change at any time. Additionally, observational data will be collected onsite using trained clinicians who will observe and record time spent on care provision, including taking care to differentiate time spent on care provision from time spent on administrative nursing. [2] The COVID-19 Public Health Emergency (PHE) has highlighted and exacerbated the long-standing staffing challenges experienced in many facilities, creating an urgent need to address this issue for the well-being of all individuals residing in our nations federally certified nursing homes and the workers who care for them. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. 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. 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. Nominate Now. In addition to administrative agency action, Congress could adopt legislative changes, though it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation would be included in another budget reconciliation package that is possible this summer. In response to the COVID-19 public health emergency, CMS temporarily waived the training requirement as a means of addressing potential staffing shortages during the pandemic. They're burned out. Find nursing staff with a variety of specialties, including geriatric nursing, palliative care nursing, and more. 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. At least five states adopted permanent increases to nursing home minimum staffing requirements after the onset of the COVID-19 pandemic, while at least one state adopted a permanent decrease (Figure 2 and Appendix Table 1). 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. 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. At least 1.1 hours of care must be given by a registered nurse (RN) or licensed practical nurse (LPN). 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. 0000004038 00000 n "You have an opportunity to turn this industry on its head. 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. To meet the nursing needs of all residents. It is even more so now.". [2] In the same survey, more than 7 out of 10 long term care facilities said a lack of qualified candidates and unemployment benefits have been the biggest obstacles in hiring new staff.[3]. 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. 0000006860 00000 n SPONSORED BY: Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. [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. 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. That resident may end up waiting in soiled bedclothes for a while. 5376 (117th Congress) (2021-2022). Belle Harris The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. We include both permanent and temporary changes to illustrate the types of action states are taking. The Biden Administration has announced plans to propose new federal minimum staffing adequacy regulations in the next year. CMS 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, which includes conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. Quantitative analysis will use secondary data, including Medicare Payroll-based Journal (PBJ) data, Minimum Data Set (MDS), and Medicare claims. 0000001178 00000 n 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. Federal government websites often end in .gov or .mil. 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. "They're tired. Numerous studies have shown that understaffing nursing homes can harm the health of residents, who suffer more bedsores, more weight loss, more overprescribing of anti-psychotic medications, and during the pandemic more COVID-19 cases and deaths. An official website of the United States government. Interviews with nursing home leadership, direct care staff (including RNs, LPNs/LVNs, and CNAs), and residents and their family members will be conducted to better understand the relationship between staffing levels, staffing mix (what types of staff are present), and resident outcomes and experiences (i.e., clinical outcomes, safety, health disparities) using rich contextual information collected during the interviews. What are the next steps and how can I get involved? 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. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. The bad days are more likely to be those when the facility is short-staffed. Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. At least four states adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic (Figure 2 and Appendix Table 2). CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. 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. While you await upcoming CMS guidance on minimum staffing requirements, you can always look to current nursing home staffing requirements by For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. While the staffing requirements may be changing, here are the current staffing guidelines, according to the State Nursing Home Staffing Standards Summary Report for the markets supported by NurseDash. 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. 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. Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. Cannot go below 1:40 RN/LPN ratio. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. In But she's also looking into how the taxpayer money pouring into nursing homes, in particular those owned by private equity firms, is being spent. 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. One after another. hide caption. Contact us now for staffing assistance. The law requires the states more than 600 nursing homes to provide 3.5 hours of care per resident per day. The White House on Monday unveiled a slew 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.. Senator Bob Casey Jr. outlining their concerns about a proposed federal staffing requirement by the Centers for Medicare and Medicaid ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. Welcome to the Nursing Home Resource Center! 0000006058 00000 n 0000004472 00000 n 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 law was first introduced by former Gov. 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