Federal officials propose new standards for nursing homes to increase staffing

Citing to labor shortages, care home operators said the standard could not be met without additional funding for higher wages.

The nation's understaffed nursing homes would be required to hire more workers under new rules proposed Friday by the Biden administration , the biggest change to federal nursing home regulations in three decades.

The proposed standard was prompted by the industry's troubled performance in the early part of the coronavirus pandemic, when 200,000 nursing home residents died. But the proposal falls far short of what industry and patient advocates say is needed to improve care for most of the 1.2 million Americans in nursing homes.

The proposal, by the Centers for Medicare and Medicaid Services, would require all facilities to increase their staff to certain minimum levels, but it provided no money for nursing homes to pay for new hires.

C.M.S. It is estimated that three-quarters of the country's 15,000 households would need additional staff. But increases at many of these facilities would be minor, as the average nursing home already employs nurses and orderlies at, or very close to, the levels offered.

"The standards are far lower than many experts, myself included, have claimed over the years," said David Grabowski, professor of health policy at Harvard Medical School. positive here, but I wish the administration had gone further."

The government has said it will exempt nursing homes from any penalties if they could prove that there were problems. There was a local labor shortage and that the establishments had made sincere efforts to recruit employees.

“Fundamentally, this standard is totally inadequate to meet the needs of nursing home residents. said Richard Mollot, executive director of the Long Term Care Community Coalition, a New York-based advocacy group.

Retirement home industry leaders said that without additional money from Medicare or Medicaid—the two federal insurers that fund most nursing home care—this requirement would be financially unattainable.

no sense in imposing staffing levels that cannot be met," Katie Smith Sloan, president and chief executive of LeadingAge, an association that includes nonprofit retirement homes, said in a statement. "There's just no one to hire, especially no nurses. The proposed rule requires nursing homes to hire additional staff. But where do they come from?"

The new staffing standard would require homes to have an average daily number of nursing staff of at least 0.55 hours per resident. This translates to one registered nurse for every 44 residents. But that's below what an average retirement home already offers, or 0.66 hours per resident, or a ratio of 1:36, according to federal records.

At least a registered nurse would. must be on duty at all times under the proposed plan — one of the biggest changes for facilities, as they currently only have to have nurses for eight consecutive hours each day.

The proposed rule also provides for 2.45 hours of nursing aide per resident per day, or a ratio of approximately one nursing aide for every 10 residents. Although the federal government does not set any specific staffing requirements for nurse aides, the average home already provides 2.22 hours of nurse aide per day, a ratio of about 1:11.

“The minimum federal staffing standards proposed by C.M.S. are solid but achievable,” the agency said in a statement. “The proposal also makes it clear that digital staffing levels are a floor – not a ceiling – for safe staffing. »

Registered nurses are at the top of the chain of command. in nursing homes, overseeing resident assessments and managing complex clinical tasks. Nurses delegate simpler clinical roles to licensed practical nurses.

Certified practical nurses, often referred to as nurse aides, are usually the most numerous in a nursing home and helping residents...