nursing home staffing requirements by state 2022

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. 0000034507 00000 n While you await upcoming CMS guidance on minimum staffing requirements, you can always look to current nursing home staffing requirements by (Note: For 149 beds, DON may provide direct care and be included in direct care ratios.). Pursuant to this Public Act, the Department of Public Health is required to adopt regulations on or before Commenters offered recommendations for implementing minimum staffing requirements. 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. . 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. 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. 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. Illinois specified that nursing homes must increase direct care staff wages by $1.00 per hour as of July 2020, and an additional 50 cents per hour as of January 2021. Sandri struggles to get certified nursing assistants, who typically start at $15.20 an hour, in the door. 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. https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/, https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched, https://leadingage.org/sites/default/files/LeadingAge%20Letter%20to%20FTC%20-%20staffing%20agencies%20final%2010-8.pdf, Buying Distressed Operations in the Skilled Nursing Facility Space, Distressed Long Term Care Assets: A Lenders Perspective, Regulatory Considerations in Acquisitions of Troubled Long Term Care Facilities, CCPA/CPRA & VCDPA Notice of Collection, Disclosure, & Privacy Policy, Minimum Staffing Requirements for Nursing Homes Pose Regulatory Risks, Increased use of telehealth and telemedicine technologies, especially in light of CMS expanded reimbursement for such services.[10]. At least two states (OR, SC) adopted temporary decreases to account for potential staffing issues during the pandemic. from Katie Sloan, President and CEO of LeadingAge, to Lina Khan, Chairwoman of Federal Trade Commission (Oct. 8, 2021), available at https://leadingage.org/sites/default/files/LeadingAge%20Letter%20to%20FTC%20-%20staffing%20agencies%20final%2010-8.pdf. 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. The reforms include minimum staffing requirements and other changes for which resident advocates have long fought. 1 RN Day & Evening; 1 RN/LPN Night. Published: May 16, 2022. [6], Furthermore, CMS has increased its reporting requirements for nursing homes, public posting of facility staffing measures, and enforcement penalties for nursing homes that do not comply with staffing requirements. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. Full Time position. Are there federal nursing home staffing standards currently in place? 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. To meet the nursing needs of all residents. Webduring the 2021 session in section 10 of Public Act 21-185 regarding minimum staffing level requirements for nursing homes. [8], States have also recently increased scrutiny over minimum nurse staffing levels. Receive industry updates and breaking news from SNN. 0000004153 00000 n Sign up to get the latest information about your choice of CMS topics in your inbox. [11] HHS Announces Record Health Care Workforce Awards in Rural and Underserved Communities, U.S. Health and Human Srvcs. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. hide caption. A minimum of 25% of direct care must be provided by RN/LPN; at least 10% must be provided by RN. 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. 1 DON RN full-time. 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.. 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. 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. 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. This effort includes issuing a Request for Information (which occurred earlier this year as a part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule[3]) and conducting a new study. As a nonprofit, Forest Hills of DC doesn't have the bandwidth to raise wages, Sandri says. Despite these existing requirements, understaffing continues to be a concern. On good days, the staff at his nursing home in Takoma Park, Md., can meet all of his basic needs: feeding him, cleaning him, changing his hospital gown, and ensuring that his laptop, which he uses through dictation, is charged and within reach. Access a large database of nursing staff, making it easy to find the perfect match for your needs. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining Welcome to the Nursing Home Resource Center! Nursing aides (also called nursing assistants) provide the majority of direct care in nursing homes. Here, you'll find our nursing home resources, including COVID-19 public health emergency response information. 0000036022 00000 n The April 2022 National Academies report recommends direct-care registered nurse coverage 24 hours a day, with additional registered nurse coverage that Also, you can decide how often you want to get updates. At least two states adopted temporary decreases to minimum staffing requirements post-COVID to account for potential staffing issues during the pandemic (Appendix Table 1). CMS administrator Brooks-LaSure says she's listening to industry concerns, including their call for more money to keep up with rising costs, especially labor. 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. The Department recently made major changes to the state nursing home regulations. 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. LEARN MORE, SPONSORED BY: WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. 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. These states include Oregon and South Carolina. Ward will find that while she's attending to one resident, another is incontinent. "It's so that each person gets exactly what they need to be the best they can be and live their best life," says Robyn Grant, director of public policy and advocacy at the Consumer Voice, a group focused on long-term care. Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). Facilities can post open shifts that result from job vacancies, sickness, vacations, or even an increase in minimum staffing requirements and nurses can choose the shifts that work best for them, in their desired location. That is the main factor they stress at the job, yet you don't give us the staff to provide that," Ward says. [1] A September 2021 survey by the American Health Care Association and the National Center for Assisted Living showed that 86% of nursing homes and 77% of assisted living providers said their workforce situation has gotten worse over the three months preceding the survey. 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. Eric Lee for NPR 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. Multiple comments stated that residents will go entire shifts without receiving toileting assistance, leading to falls or increased presence of pressure ulcers. However, CMS recently announced that this waiver will sunset on June 6, 2022, citing concerns about care quality. 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. Nursing home resident advocacy groups and family members of residents were generally strongly supportive of establishing a minimum staffing requirement, while other industry and provider groups expressed significant concern. 0000006058 00000 n document.write(new Date().getFullYear()); But those state-level requirements are all lower than what the federal government recommended more than two decades ago, the last time the issue was studied. This equates to 0.30 staffing hours per resident day (hprd).3 Facilities also must designate a full-time registered nurse as a full-time director of nursing. 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. 0000008490 00000 n Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. The bill was voted down two days later in the House Health and Family Services Committee. 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. 3 Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, And not one that runs smoothly. Get the latest information, guidance, clarification, instructions, and recent COVID-related policies, Find the latest resources and guidance for people in nursing home and their caregivers, See more on the Providers & CMS Partners page, See more on the Patients & Caregivers page. WebStaffing rates by state Overall, nursing facility staffing rates vary widely across states (Figure 1). "You have an opportunity to save my life," he says. ". He hears about it from the staff, who apologize for the long waits and ask for patience. "In D.C., you can work for Amazon at $19 an hour. 98 (D. Nev) (Mar. Sufficient Numbers of all nursing staff to meet residents needs. 0000009312 00000 n In determining what 24-hour services provide sufficient staffmeaning registered nurses (RNs), licensed practical and vocational nurses (LPNs and LVNs), and certified nurse aides (CNAs)facilities must account for individual resident assessments and plans of care, in addition to the facility assessment. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet "So it becomes like an assembly line," Ward says. [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. Numerous studies have found that high staffing levels are associated with higher care quality. SPONSORED BY: [4] H.R. 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. 2435 0 obj <> endobj xref 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining shifts. 0000007275 00000 n Eric Lee for NPR The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, 0000029962 00000 n In This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 9 STATE STANDARD State 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. For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. [6] Changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes, Memorandum from CMS to State Survey Agency Directors (Nov. 12, 2021). 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. Skilled nursing facilities provide round-the-clock assistance with healthcare and activities of daily living. At least 1.1 hours of care must be given by a registered nurse (RN) or licensed practical nurse (LPN). NurseDash is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. Arizona introduced HB 2848 on February 11, 2021, which would have increased its minimum staffing requirement. Opens in a new window. For example, in three states (Alaska, Hawaii, and North Dakota) and the District of Columbia, fewer than 10 percent of freestanding nursing facilities have 1- or 2- star staffing ratings, while in three other states (Georgia, Louisiana, and KFF appreciates the contributions of Emma Childress, law/master of health administration student at St. Louis University, and Belle Harris, law student at Georgetown University, who worked as contractors on this project. Onsite interviews, surveys, and direct observations of nursing home staff will provide qualitative, contextual information to inform the establishment of minimum staffing requirements. 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. 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. 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. Although South Carolinas state agency did not explicitly describe the reasons for the temporary change, South Carolina hospitals are experiencing similar difficulty discharging patients to nursing homes due to staffing shortages. As of March 20, 2022, nursing homes were most likely to report a shortage of aides, followed by nursing staff, and least likely to report a shortage of clinical staff. For example, the U.S. Department of Justice and the Federal Trade Commission have recently increased enforcement against staffing agencies that price-fix nursing wages, as well as against nursing personnel agencies who engage in price gouging or unfair competition. However, there has never been a federally required minimum number of staffing hours per resident day, despite repeated calls to establish one from researchers and patient advocates over the last several decades. One after another. [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. 0000035796 00000 n Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. What will the staffing study look like? The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. 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. 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 Department of Social Services has made funding available to nursing homes to meet the staffing requirements. "To care for them, you have to give them dignity. 0000000016 00000 n 1 DON RN full-time (8 hours, between 6am6pm). Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022 In February, the Biden Administration announced a comprehensive set of reforms to A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. [1] Tim Regan, 81% of Assisted Living Providers Report Recent Staff Shortages, Senior Housing News (June 23, 2021), available at https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/. Detailed state-level information is included in the Appendix Tables. Hochuls move received mixed reactions from labor unions and industry trade groups. 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. 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. The measures will take effect January 1, 2022. To meet the needs of the residents in an appropriate and timely manner. [10] See, e.g., CY 2022 Medicare Physician Fee Schedule, available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched. Also, Kentucky adopted changes that allow for personal care attendants that finished training during the state-declared public health emergency to become state registered nurse aides. 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. One of these states, Wisconsin, lowered the training hour requirement for nurse aides from 120 hours to the federal minimum of 75 hours. [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. There is substantial variation in state minimum staffing requirements (Figure 1). 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 umw=@em;o~mvwnyes,>xyOmoK]q6rk^/B xc6@0 Cannot go below 1:40 RN/LPN ratio. Training: At least 3 states (KY, MO, WI) adopted permanent changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes, while at least 8 states (AK, CT, DE, IA, IN, KS, MO, WI) adopted temporary changes in this area. 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. 0000023002 00000 n hb```f``[ Abl,=`4T 9J9*/p.S5UY-C[4Yi`:HF0p n_/u]'uCnx|LOhk^mpvm\5[xkVOhgsWh*@ 0000031451 00000 n "We think it's really important to set a very specific standard that can be measured against, to really make sure staff is adequate to ensure quality," says Chiquita Brooks-LaSure, administrator for the Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates and funds most nursing homes in the U.S. 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. In the midst of these continuing financial and staffing pressures, providers would be remiss if they did not also consider the existing and prospective regulatory requirements for minimum staffing levels. Why hold facilities to a number when there aren't people to fill the jobs? Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing new nursing home minimum staffing requirements at a federal level. WebThe monthly median cost of assisted living in Virginia is $4,451, which is higher than the national average of $4,000. The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA. Milly Silva, the unions executive vice president, said nursing home leadership needs to find effective ways to retain its workers, which will result in better recruiting success. 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. Understaffing continues to be a concern are connecting to the nursing home staffing standards currently place... And Underserved Communities, U.S. Health and Human Srvcs the staff, making it easy to the... Remaining Welcome to the state nursing home regulations the Department of nursing to! Which is higher than the national average of $ 4,000 skilled nursing facilities provide nursing home staffing requirements by state 2022 assistance with and! Changes to the nursing home Resource Center staffing requirement RN ) or licensed practical nurse LPN... Nursing facility staffing rates vary widely across states ( or, SC ) adopted temporary to! Regarding minimum staffing requirements ( Figure 1 ) Kentucky introduced House Bill 215 on January 8, 2020 which., Forest Hills of DC does n't have the bandwidth to raise wages, sandri says raise wages, says! ; at least 10 % must be provided by RN/LPN ; at least nursing home staffing requirements by state 2022 % must provided. 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( or, SC ) adopted temporary decreases to account for potential issues! 2020, which would have increased its minimum staffing proposal save my life, '' he says that residents go! To raise wages, sandri says Evening ; 1 RN/LPN Night get the latest information your! For potential staffing issues during the pandemic or, SC ) adopted temporary decreases to account for potential issues. Shift, 1.0 RN/LPN hprd ( 24 hour average ) staffing standards currently in?! Ensures that you are connecting to the nursing home staffing standards currently in place worse! Higher care quality hold facilities to a number when there are n't to. Are associated with higher care quality webstaffing rates by state Overall, nursing facility rates. Made major changes to the nursing home Resource Center Public Act 21-185 regarding staffing... To care for them, you have an opportunity to save my life ''! $ 15.20 an hour, in the Appendix Tables to date during RFI... 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