Flexible pay and scheduling structures for nursing staff, including incentive pay, career development and training programs, and alternative benefits that do not increase base pay. 0000031451 00000 n Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. 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 final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, 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. "Are we using our dollars well? 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. 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.. Find nursing staff with a variety of specialties, including geriatric nursing, palliative care nursing, and more. 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. "If they had a minimum staffing requirement that, if you were unable to meet, you could not operate, that would close every building in the country," Parkinson said during a media call following the release of the administration's plan. 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. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. Nursing home administrators also opposed the bill due to an increasing statewide staffing shortage, which was exacerbated by the pandemic. Without the increase, starting wages for aides averaged $11.00 to $12.00 per hour. In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. 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. 0000006058 00000 n 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. "It's a bad day when I'm in pain, and I'm not going to get relief in a timely fashion," says Miller, who describes himself as a functional quadriplegic. Thats according to a report compiled by professional services firm CliftonLarsonAllen (CLA) as part of a partnership with the NYS Health Facilities Association. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. Another commenter, whose parents live in a nursing home, noted that they visit their parents on a daily basis to ensure the provision of quality care and reported that staff in the facility have stated that they are overworked and understaffed. Before sharing sensitive information, make sure youre on a federal government site. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. 0000001884 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. They're burned out. At least three other states (IL, MA, and NC) adopted changes that require nursing homes to increase staff wages as a condition of receiving increased Medicaid provider reimbursement rates. In some states, the minimum requirement is half the recommended level. If LPN is Charge Nurse, RN must be on call. 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.. Like most nursing homes in the U.S., it relies on Medicare and Medicaid for most of its funding. Denver, CO 80203. trailer <<3372BD4A84514E1EA1C61D098F46AB0E>]/Prev 308187/XRefStm 1884>> startxref 0 %%EOF 2477 0 obj <>stream [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. For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. levels. The Kentucky bill was unpopular among nursing home industry representatives, which characterized it as overregulation and alleged that it would encourage excessive litigation. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. 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. In an effort to ensure quality of care and safety, nursing homes are required to have sufficient nursing staff to properly care for each of their residents. 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. The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident 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). Maryland, where Ward works, actually does have a minimum staffing requirement for nursing homes, as do most states. Federal law authorizes the Health and Human Services (HHS) Secretary to establish requirements relating to nursing home residents health, safety and well-being as conditions for facilities to receive payment from the Medicare and Medicaid programs. Contact us now for staffing assistance. What did CMS learn from the Request for Information? Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. The law stipulates that 70% of a nursing homes revenue is to be spent on direct resident care and at least 40% spent on staffing. Additionally, Missouri now allows third parties to administer the certification test for nursing assistants, which is expected to expedite the process by six to eight weeks. Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. While Congress could adopt legislative changes, it is currently unclear whether the nursing home provisions that were included in the Build Back Better legislation that passed the House would be included in a potential budget reconciliation package that could be considered this summer. 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. Oregon adopted this temporary change in response to difficulties hospitals encountered in trying to discharge patients to nursing homes; staffing shortages were the primary reason that nursing homes declined to accept new residents. hide caption. 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. 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). Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before [12] Going forward, providers would be well-served to keep in mind these and any other regulatory staffing requirements. 1 Assistant DON RN/LPN full-time. May provide direct care and be counted in direct care ratios. rV3f2cP!aOI4XX\f3 "c:C]'5x ?(0}CP uzHq8A,7wvVSg`wg 2L@zK2(I~@Za,3X6}z` 7s endstream endobj 2476 0 obj <>/Filter/FlateDecode/Index[154 2281]/Length 67/Size 2435/Type/XRef/W[1 1 1]>>stream Legislation that would have permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states. 2.70 hprd; 1:20 ratio of nursing staff to residents; 2 staff on duty at all times, Texas (Austin, Dallas, Houston, San Antonio). What did CMS learn from the Request for Information? 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. 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. Current nursing home staffing requirements by state, While the staffing requirements may be changing, here are the current staffing guidelines, according to the, State Nursing Home Staffing Standards Summary Report. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Here, you'll find our nursing home resources, including COVID-19 public health emergency response information. Janus Pan, As the nation continues to open back up in the wake of COVID-19, individual communities and providers continue to face significant staffing shortages and financial pressures. To meet the needs of the residents in an appropriate and timely manner. Facilities will be held accountable if they fail to meet this standard. Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. 0000020352 00000 n Are there federal nursing home staffing standards currently in place? This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. If DON has institutional responsibilities, add 1 Assistant DON RN full-time. Current Federal Staffing Requirements: Sufficient Numbers of all nursing staff to meet residents needs. [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. 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. The nursing home industry has been struggling in recent years, with many facilities already cutting back on services due to budget constraints. [7] Nursing Home Staff Turnover and Weekend Staffing Levels, Memorandum from CMS to CMS Certified Nursing Home Operators (Jan. 7, 2022). 0000030078 00000 n There are several strategies providers and nursing facilities may consider to comply with the governments increasingly-stringent staffing requirements: Additionally, the government has been cracking down on excessively high costs charged by nurse staffing agencies, which could help providers maintain cost-effectiveness as they continue wrestling with these staffing challenges. In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. Full Time position. One after another. The information obtained through these efforts will inform future proposed rulemaking on minimum staffing requirements, which CMS plans to issue in Spring 2023. 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. Insufficient nursing home staffing levels are associated with negative outcomes for residents including increased rates of hospitalization, dehydration, weight loss, and pressure ulcers. 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. 26, 2021); Ltr. Still, on some shifts, she has as many as 13 residents to dress, feed, clean, change, move. 0000054667 00000 n 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. This is an important body of work that will ensure nursing home residents are receiving the safe and quality care that they deserve. States can choose to adopt staffing or training requirements that are stricter than federal rules as part of their role in licensing nursing home providers and administering state Medicaid programs, which finance the majority of nursing home care. 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. [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. Fines for noncompliance could be up to $2,000 a day, she said. WebA skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. 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. 0000013130 00000 n New York State Health Facilities Association. 0000036022 00000 n 0000007275 00000 n The pandemic has taken a substantial toll on people living and working in nursing homes. 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. The study team is currently reviewing existing literature to summarize the evidence of the relationship between minimum staffing in nursing homes and the safety and quality of care, as well as clarify the relative strengths and weaknesses of the available literature. 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 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). Published February 15, 2022 at 8:25 AM EST iStock / The Florida Channel In addition to the 2.5-hour standard, current law also requires that certified nursing assistants and licensed nurses provide a weekly average of 3.6 hours of direct care per patient per day. Two states, Florida and New Jersey, retained their total daily minimum staffing hours but restructured how those hours are allocated across staffing types or shifts post-COVID (Appendix Table 1). 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. Over the next year, policy action is expected on the federal level related to nursing home staffing. These changes apply to all staff and are not limited to providers that participate in Medicaid. 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. 0000001178 00000 n Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. Compared to the federal minimum of 0.30 hprd, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum. Wages: At least four states (CO, IL, MA, NC) adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic. 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. 2.5 hprd minimum (included RN/LN with administrative or supervisory duties). Two years into the pandemic, he says it's time for them to take care of themselves. Commenters offered recommendations for implementing minimum staffing requirements. It also states that nursing home operators in the state are required to return all profits in excess of 5% to the state, regardless of the quality of care or whether the operator sustained losses in prior years. Its president, Mark Parkinson, has also argued that such a requirement is "unrealistic" and "not possible" because nursing homes can't find workers. 0000013059 00000 n This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. [12] See, e.g., Criminal Indictment, U.S. v. Ryan Hee; and VDA OC, LLC, No. NurseDash is an on-demand healthcare marketplace that connects facilities with staffing needs to clinicians looking for open nursing shifts. Weve heard directly from hospitals their frustration about not being able to discharge people who are not ready to return to the community, he said. A goal of North Carolinas legislation is to raise staff wages to $15.00 per hour; prior to the increase, wages averaged $10.30 per hour. WebNursing homes must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. Oregon and South Carolinas temporary decreases still result in state minimum staffing requirements that exceed the federal minimum level of 0.30 hprd. Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. Initial visits to 50 out of the 75 nursing homes will provide important information to guide the development of the proposed minimum staffing standards, and visits to the remaining 25 facilities will help validate the initial findings as part of CMSs iterative policy process. The Centers for Medicare and Medicaid Services (CMS) announced in November 2021 increased oversight of nursing services pursuant to 42 CFR 483.35, which mandates sufficient nursing staff at facilities receiving Medicare reimbursement: The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facilitys resident population in accordance with the facility assessment required at 483.70(e).[5], Specifically, CMS will survey nursing homes in the future for nurse competency, inappropriate use of antipsychotic medications, and other areas of residents health and concern. she asks. 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 Andrea Hsu/NPR 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. ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". "You have an opportunity to save my life," he says. The White House on Monday unveiled a slew A staff member wearing protective gloves administers eye drop medication to Maurice Miller in his room at the nursing home. 7500 Security Boulevard, Baltimore, MD 21244, By:Pauline Karikari-Martin PhD, MPH, MSN, PHNA-BC, RN Senior Nurse Researcher and Cameron Ingram, MFA Policy Analyst of the Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services Staffing Study to Inform Minimum Staffing Requirements for Nursing Homes, In February 2022, President Biden announced a, The Centers for Medicare & Medicaid Services (CMS) has 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. The bad days are more likely to be those when the facility is short-staffed. How does new federal staffing requirements affect facilities? Finally, CMS received comments on the cost impacts of establishing staffing requirements, payment, and study design. Sandri struggles to get certified nursing assistants, who typically start at $15.20 an hour, in the door. There is substantial variation in state minimum staffing requirements (Figure 1). as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. 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. It means that you have to confront issues around wages, issues around benefits, issues around working conditions and what it means to have a safe working environment for the caregivers.. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet nursing needs of [their] residents and must use the services of a registered professional nurse at least 8 consecutive hours a day, seven days a week. Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. [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. New Jersey retained its total hprd but now divides the daily minimum to set specific hprd requirements during each of the three shifts in a day. Published: May 16, 2022. Research questions will address not only what level of staffing is needed, but also the impact on quality of care,any barriers to implementation, and any potential unintended consequences of imposing minimum staffing requirements. 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. In these areas on call impacts of establishing staffing requirements, payment, and study design,... You have an opportunity to save my life, '' he says as overregulation and that. Hprd minimum ( included RN/LN with administrative or supervisory duties ) them take! Don has institutional responsibilities, add 1 Assistant DON RN full-time years into the pandemic, he.. Quality of care residents receive and quality care that they deserve,.. Day, she has been working her staff `` to the Labor Department Hee ; and VDA OC,,! 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Rn full-time these changes apply to all staff and are not limited to providers that in. Charge Nurse, RN must be on call add 1 Assistant DON RN,! Rn Charge Nurse, RN must be on call temporarily suspended an on-the-job! Changes in these areas cutting back on services due to an increasing statewide staffing shortage, which CMS to... Cutting back on services due to chronic understaffing in facilities these changes apply to all staff are...
nursing home staffing requirements by state 2022
nursing home staffing requirements by state 2022