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

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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.

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More about Nursing home staffing regulations

• Biden administration announces nursing home staffing regulations
• Advocates disappointed with proposed nursing home staffing levels
• American Health Care Association’s response to proposed regulations
• Details of President Biden’s 2022 State of the Union speech
• Comparison of proposed staffing requirements to current levels
• Impact of COVID-19 pandemic on nursing home staffing
• Discussion on workforce crisis in nursing homes