US will regulate nursing home staffing for first time, but proposal lower than many advocates hoped

by Joshua Brown
Nursing home staffing regulations

The United States is set to introduce new regulations that will establish minimum staffing levels at nursing homes, marking the first time that such guidelines will be imposed by the federal government. The Biden administration’s decision comes as a response to the significant issues exposed by the COVID-19 pandemic, which resulted in a large number of deaths within nursing homes due to systemic problems.

Although advocates for older adults and individuals with disabilities have long sought such regulations, the proposed staffing requirements have fallen short of their expectations. This announcement has garnered criticism from the nursing home industry, which views the proposed guidelines as an unattainable mandate.

The unveiling of these regulations follows a promise made by President Joe Biden during his 2022 State of the Union address. Health Secretary Xavier Becerra emphasized the importance of establishing minimum staffing standards to enhance the safety of nursing home residents, particularly emphasizing the negative consequences of understaffed facilities on residents’ well-being.

However, the American Health Care Association (AHCA), which advocates for care facilities, expressed deep concern over the proposal, deeming it “unfathomable.” The AHCA’s president, Mark Parkinson, a former Democratic governor of Kansas, argued that the rule lacks a foundation, proper funding, and practicality.

The newly proposed rules, which are entering a public comment phase before full implementation, stipulate that nursing homes should maintain staffing equivalent to a minimum of 3 hours per resident per day. Registered nurses (RNs) would contribute slightly over half an hour of this total, and the regulations also require the presence of an RN on staff 24 hours a day, every day.

Comparatively, the average nursing home in the United States currently provides approximately 3.6 hours of caregiver staffing per resident per day, with RN staffing just surpassing the half-hour mark. Despite this, the government asserts that a majority of the country’s approximately 15,000 nursing homes, housing around 1.2 million people, will need to increase staffing under the proposed guidelines.

Chiquita Brooks-LaSure, who oversees nursing homes as the head of the Centers for Medicare and Medicaid Services (CMS), referred to this move as a crucial initial step. A senior White House official mentioned the administration’s openness to reassessing the staffing threshold once it is implemented.

Stacy Sanders, an aide to Health Secretary Xavier Becerra, stressed that maintaining the existing status quo without federal minimum staffing standards is not preferable to the proposed rules. Sanders emphasized that the new standards would result in elevated staffing levels for over 75% of nursing homes, increasing the presence of nurse aides and ensuring a registered nurse is on-site 24/7.

It’s worth noting that the newly proposed staffing thresholds are considerably lower than the benchmarks advocated for by proponents of nursing home reform. A significant study funded by CMS in 2001 recommended an average of 4.1 hours of nursing care per resident daily, a threshold that most facilities do not currently meet. Critics argue that even this recommended threshold is insufficient, as it solely focuses on preventing potential harm to residents without fully addressing their quality of life.

The issue gained heightened attention during the COVID-19 pandemic, which exposed the dire consequences of inadequate staffing in nursing homes. Advocates initially welcomed President Biden’s commitment to address this issue in his State of the Union speech, but their enthusiasm waned after the announcement of the proposed staffing regulations. The inadvertent release of a CMS-funded study claiming that there is no obvious plateau for optimizing quality and safety further disheartened advocates, who felt betrayed by the administration.

Despite differing opinions, the proposed regulations are expected to bring about changes in the nursing home industry. The public comment period will provide an opportunity for stakeholders to express their views before the rules are fully implemented.

Frequently Asked Questions (FAQs) about Nursing home staffing regulations

What are the new regulations introduced for nursing homes in the US?

The federal government has introduced regulations to establish minimum staffing levels at nursing homes for the first time. These regulations aim to address systemic problems highlighted by mass COVID-19 deaths.

How have advocates and the nursing home industry responded to the proposed staffing levels?

Advocates for older adults and those with disabilities have sought staffing regulations for years, but the proposed thresholds are lower than expected. The nursing home industry has expressed concern, viewing the regulations as unattainable and potentially detrimental.

What was President Biden’s stance on nursing home staffing?

President Biden emphasized the importance of minimum staffing standards for nursing homes in his 2022 State of the Union speech.

How do the proposed staffing requirements compare to the current staffing levels?

The proposed rules call for a minimum of 3 hours of staffing per resident per day, with registered nurses contributing slightly over half an hour. Currently, the average nursing home provides around 3.6 hours of caregiver staffing per resident per day.

How many nursing homes and residents are affected by these regulations?

The regulations could impact a majority of the approximately 15,000 nursing homes in the US, housing about 1.2 million people.

What is the perspective of the American Health Care Association (AHCA) on the proposed rules?

The AHCA, which advocates for care facilities, has criticized the proposal as “unfathomable,” citing concerns about its feasibility and financial implications.

How will the regulations affect staffing levels in nursing homes?

The government believes that the majority of nursing homes will need to increase their staffing levels to meet the proposed standards.

What is the significance of having a registered nurse (RN) on staff 24/7?

The proposed rules emphasize the requirement for nursing homes to have an RN on-site 24 hours a day, every day, to ensure continuous and immediate medical care.

How do these regulations compare to previous recommendations?

The newly proposed staffing thresholds are significantly lower than previous recommendations, which had called for an average of 4.1 hours of nursing care per resident daily.

What impact did the COVID-19 pandemic have on nursing home staffing?

The pandemic exposed the dire consequences of poor staffing in nursing homes, leading to increased attention on this issue.

How has the nursing home industry’s workforce been affected recently?

Data shows that nursing homes have had 218,200 fewer employees compared to pre-pandemic levels, impacting staffing in these facilities.

More about Nursing home staffing regulations

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CarEnthusiast September 1, 2023 - 9:33 pm

so, nursing homes and staffing, huh? not sure if this rule gonna fix stuff. hope those in charge figure it out, need better care 4 seniors.

NewsJunkie101 September 1, 2023 - 10:43 pm

nursing homes, staffing, it’s a story! biden throwin’ rules, industry’s pushin’ back. gonna be a long debate, folks.

CryptoTrader87 September 2, 2023 - 2:35 am

not into nursing homes, but staffing rules matter. biden’s plan, industry’s fightin’. curious how it plays out in the end.

EconGuru September 2, 2023 - 3:18 am

staffing regs in nursing homes, interesting move. biden’s pushin’, industry pushin’ back. let’s see who wins this round.

PoliticsBuff September 2, 2023 - 5:02 am

nursing home staffing saga continues. biden wants rules, industry ain’t feelin’ it. gotta find middle ground, maybe?

BizInsider September 2, 2023 - 7:13 am

biden goes, “staffing rules, nursing homes!” industry’s like, “nah, not happenin’.” wonder if they’ll find common ground.

Joan123 September 2, 2023 - 9:45 am

omg this new rule about nursing home staffing is like, whoa! some say it’s good, others like nah, too low! wonder what’s gonna happen next, ya know?

AutoAficionado September 2, 2023 - 1:42 pm

cars may be my thing, but nursing homes? they need more staff. biden’s pushin’, industry ain’t buyin’ it. let’s watch this unfold.

CryptoQueen September 2, 2023 - 5:05 pm

while crypto’s my jam, nursing homes and staffing be a hot mess. gov tryna make rules, but will it help? we’ll c!

FinanceWizard September 2, 2023 - 5:50 pm

biden’s like “hey nursing homes, let’s do this staffing thing” but the industry’s like “nah, can’t do it, dude!” gonna be a big debate, 4 sure.


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