A shortage of healthcare workers nationwide could worsen once nursing homes are required to meet minimum staffing requirements set by the federal government.
The Centers for Medicare and Medicaid Services issued the long-awaited proposed mandate late last week and estimated approximately three-quarters of the nation’s more than 15,000 nursing homes receiving Medicare and Medicaid funding would have to hire more nurses and certified nursing assistants to comply with the rule.
Here's what to know about the proposal and what's next.
What does the proposed mandate require?
Nursing homes would have to provide a minimum of three hours of nursing care per resident, per day. At least 0.55 hours must be provided by registered nurses and at least 2.45 hours must be provided by nurses aides. The draft regulation also requires that a nurse be on duty at all times. The regulation would be rolled out over three years for nursing homes in urban areas and five years for nursing homes in rural communities. How does the rule compare to current policy?
Federal rules require a licensed practical nurse to be on duty at all times and that at least one registered nurse be present for eight hours each day. Nursing homes must have “sufficient” staff, but there is no specific definition of what that is. Thirty-eight states have nursing home staffing minimums of their own, with some exceeding the federal rule. The District of Columbia has a minimum staffing rule of 4.1 hours per resident, per staffing day. Rhode Island and Illinois have staffing minimums of 3.8 hours per resident, per staffing day.
Why regulate nursing home staffing?
The nursing home industry came under increased scrutiny during the COVID-19 pandemic when 3.2 million residents and staff were infected by the virus and 170,000 of them died, according to the Centers for Disease Control and Prevention. As a result, approximately 250,000 workers left the industry, according to the American Health Care Association, a nursing home trade group.
“When facilities are understaffed, residents suffer,” Health and Human Services Secretary Xavier Becerra said last week in a statement announcing the mandate. A 2023 study commissioned for CMS echoed a previous report linking care quality to higher staffing levels but the study did not recommend a specific one-size-fit-all standard for the industry as it did in 2001 when it recommended a minimum of 4.1 hours per resident day.
What will this mean to nursing homes?
CMS estimates the proposal would cost nursing homes $40.6 billion over 10 years. Nursing home trade organizations, such as the American Health Care Association and LeadingAge, blasted the proposed rule, claiming a shortage of healthcare workers will make it difficult for providers to comply. The National Rural Health Association said the rule could be especially onerous in rural communities where some nursing homes have not been able to fill some positions for nearly two years. “Rural nursing homes will have two options: increase staff, which will be costly, or lower the number of beds,” said Brock Slabach, the association’s chief operating officer.
How would the rule affect the healthcare industry?
Beefing up staff at nursing homes could help alleviate the backlog of patients trying to transition from hospitals to long-term care facilities. However, the proposal could also result in increased competition for nurses and nurses aides across the industry. Last month, there were approximately 160,000 registered nurse openings nationwide, according to healthcare staffing company Aya Healthcare. Increased demand for those workers could also require providers to pay higher wages.
What is the next step?
CMS has set a 60-day public comment period for the proposed rule. All comments must be submitted to the Federal Register no later than Nov. 6. It could take several months for CMS to issue a final rule.