New Federal Rule Mandates Minimum Nursing Home Staffing Ratios
Posted on behalf of Jeff Pitman on May 6, 2024
in Nursing Homes and Elder Rights
Updated on May 7, 2024
The federal government recently announced the implementation of new staffing requirements for nursing homes across the country. The new rule is significant as it marks the first time any federal minimum staffing standard has been set. The government plans to roll out these regulations in phases over the next few years.
Those who have spent decades advocating for staffing requirements say these changes are long overdue. There is a significant amount of evidence that links higher staffing levels to improved resident care quality.
What Are the New Staffing Requirements?
Under the new federal rules, nursing homes must provide at least 3.5 hours of care per resident per day. Of that time, a minimum of 0.55 hours must be care provided by registered nurses. The remaining 2.45 hours can be provided by nurse aides and is per resident per day. This new directive aims to address the chronic understaffing issues that came to light during the COVID-19 pandemic. Staffing shortages, along with other issues, led to severe outbreaks and fatalities in nursing homes.
What Are Some of the Challenges Nursing Homes Face?
Many nursing homes, including in Wisconsin, are concerned about how they will be able to meet these standards. Many facilities in the state are still struggling with ongoing staffing shortages exacerbated by the pandemic. Currently most of the facilities in Wisconsin do not have enough nurse aides to meet these requirements.
According to an article in the Milwaukee Journal Sentinel, about three out of every five nursing homes in Wisconsin fell below these new requirements in 2023. The situation is particularly acute in rural areas, where sourcing qualified staff is even more challenging. The fear is that these regulations, while well-intentioned, might lead to nursing home closures, further straining the healthcare system by increasing hospital crowding and limiting patient care options.
Why Hiring Nurse Aides To Provide Daily Care Is Tough
Nurse aides have the unglamorous but critical responsibility for helping with the daily basic needs of residents who can no longer do things for themselves. Tasks include:
- Assisting residents getting in and out of beds and wheelchairs
- Taking them to the toilet
- Bathing residents
- Changing soiled clothing and sheets so residents do not develop bed sores
- Making sure residents drink and eat to avoid malnutrition and dehydration
- And more
Pam Klingfus, CEO of Christian Community nursing home says that despite raising wages, these positions have been hard to fill and even harder to maintain.
Tamara Konetzka, a public health sciences professor at the University of Chicago, says nursing homes may have to further increase wages to attract new nurse aides. Although wages have been increased during the pandemic, they are still lower than what an aide makes in a hospital.
Klingfus said the mandate is unfunded and that, “…the federal government missed the mark by creating the mandate without giving the funds to support it.”
Nursing Homes Claim Financial and Logistical Concerns
Nursing homes say they face significant financial pressures in implementing these changes, saying there is no federal funding to help support the new staffing level requirements. For facilities that serve Medicaid recipients, the financial strain will be especially difficult. These facilities get reimbursed at lower rates than Medicare or privately paying patients.
The other side of that argument is that there remains a lack of transparency in nursing home spending and costs. Several researchers since the pandemic have revealed that approximately 63 percent of industry profits get funneled to facility owners through various means, such as inflated rents.
The Centers for Medicare & Medicaid Services (CMS) provides more information about the finalized staffing rule more information about the finalized staffing rule.
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