Experts Urge Revision of Controversial Nursing Home Staffing Rule
TL/DR –
Leaders from the nursing industry and policy experts are urging lawmakers to scrutinize the nursing home staffing proposal by the Centers for Medicare & Medicaid Services (CMS). The proposal mandates that Medicare- and Medicaid-certified nursing homes provide a minimum of 0.55 hours per resident per day of care from registered nurses and 2.45 hours of care from certified nursing assistants, with a phase-in period of 3 and 5 years for non-rural and rural nursing homes, respectively. Concerns are being raised about the exclusion of licensed practical nurses in the legislation, the difficulty of meeting these standards given labor shortages and timing issues, the impact of the rule’s estimated cost of $4 billion per year on nursing homes already facing financial pressure, and the need to consider the unique needs of skilled nursing facilities with more medically complex residents.
Considerations for CMS Nursing Home Staffing Proposal
Healthcare leaders, including nurses and policy specialists, encourage lawmakers to reevaluate stipulations in the nursing home staffing proposal. Concerns include staff ratios, scheduling, and financial aspects that could hamper industry compliance.
The Centers for Medicare & Medicaid Services’ (CMS) proposal requires Medicare- and Medicaid-certified nursing homes to provide a minimum of 0.55 hours of care per resident per day from registered nurses (RNs), and 2.45 hours from certified nursing assistants (CNAs). Non-rural facilities have 3 years to comply, rural facilities have 5 years.
Health policy expert David Grabowski from Harvard University highlights the need to include licensed practical nurses (LPNs) in the staffing requirement, a group currently neglected in the proposal. He spoke during a webinar moderated by Lori Porter, CEO of the National Association of Health Care Assistants (NAHCA).
Grabowski emphasized the importance of scrutinizing operational and financial data to define ideal staffing levels. He urged further investigation into provider objections related to labor shortages and compliance timeline concerns.
“Quality care requires all three staff types,” Grabowski said. “Not just CNAs but also LPNs and RNs.”
Despite pandemic-related criticism towards nursing homes, Grabowski acknowledged the industry’s challenging circumstances. He also noted the need to examine cost data and potentially questionable business practices to prevent repetitive debates about bankruptcy due to compliance.
With CMS estimating the annual cost of meeting staffing requirements at $4 billion, a study by CliftonLarsonAllen suggests a higher figure of $11 billion given increased Covid-related expenses and declining Medicaid rates. This discrepancy raises concern among nursing home operators and owners.
Adjusting for SNF Acuity Levels
Provider representatives echoed Grabowski’s apprehensions. Nonprofit providers, despite superior staffing and quality metrics, worry about the rule’s potential costs. Others cited state Medicaid underpayments and the challenge of rebuilding the workforce as significant hurdles.
Geriatrician Michael Wasserman, chairman of CALTCM’s public policy committee, argued that the regulations may not adequately address the needs of skilled nursing facilities (SNFs) with medically complex residents. He emphasized the need for staffing decisions that consider the complexity and acuity of facilities’ residents and the services they require.
Wasserman also underscored the evolution of nursing homes, stating that today’s facilities serve a different population than two decades ago when CMS first proposed minimum staffing levels.
The Need for Compromise
Sherry Perry, board chair of NAHCA, advocated for nursing home operators to demonstrate empathy and be ready to compromise some profit for better elderly care. She called for the government and owners to negotiate a solution, considering the detrimental impact on residents and their caregivers.
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