Despite these existing requirements, understaffing continues to be a concern. Hochuls move received mixed reactions from labor unions and industry trade groups. One of these states, Wisconsin, lowered the training hour requirement for nurse aides from 120 hours to the federal minimum of 75 hours. In some states, the minimum requirement is half the recommended level. One key initiative within the Presidents strategy is to establish a new minimum staffing requirement. WebNew Appraisal Review Requirements and Instructions Regarding Department of Veterans Affairs Appraisal Management Service for the Lender Appraisal Processing Program and 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. On bad days, something goes wrong and it takes awhile before someone is available to respond to his call button sometimes 45 minutes or longer. Additionally, observational data will be collected onsite using trained clinicians who will observe and record time spent on care provision, including taking care to differentiate time spent on care provision from time spent on administrative nursing. This is an important body of work that will ensure nursing home residents are receiving the safe and quality care that they deserve. "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. as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. The federal government does already have some staffing requirements in place for example, each facility must have a registered nurse on duty for eight hours per day but the core language is vague. The agency initially published a Request for Information (RFI) soliciting public comments on minimum staffing requirements in April 2022, within the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. "It was a daily struggle before COVID. Monday Friday: 9am-5pm, New Nursing Home Minimum Staffing Requirements By State for 2023, New federal staffing requirements may be coming. 0000031451 00000 n Sandri struggles to get certified nursing assistants, who typically start at $15.20 an hour, in the door. The law stipulates that 70% of a nursing homes revenue is to be spent on direct resident care and at least 40% spent on staffing. Nursing homes were selected in 15 states: CA, CO, FL, IL, MA, MD, MO, NC, NY, OH, PA, TX, VA, WA, and WY. 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. 0000034507 00000 n As of December 2021, only the District of Columbia met or exceeded the minimum of 4.1 hprd recommended to prevent harm to residents. NurseDash is an on-demand healthcare marketplace that connects facilities with staffing needs to clinicians looking for open nursing shifts. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The CLA report found that it would cost anywhere from $250,000 to $1.6 million in annual costs per facility that is below the newly imposed staffing requirements. A December 2021 study reviewed state nursing home staffing standards and concluded that staffing standards in almost every state remain severely low. The Medicaid and CHIP Payment and Access Commission (MACPAC) recently reviewed state policies that can help address staffing issues, including increasing Medicaid payment rates, changing Medicaid payment methods to incentivize facilities to devote more revenue to staff, and requiring minimum staffing levels above the federal standard. Specifically, that report notes the need to improve worker wages, benefits, training, and working conditions as an integral part of improving nursing home resident health and quality of life. While federal requirements state that facilities must maintain sufficient nursing staff to meet residents needs, specific guidelines are not set and state regulations vary drastically. She aims to have a rule in place within a year, an optimistic time frame given the lengthy federal rulemaking process and other challenges. Site visits to nursing homes and related analyses. In an effort to ensure quality of care and safety, nursing homes are required to have sufficient nursing staff to properly care for each of their residents. At least three states adopted permanent changes to staff training requirements to expand the pool of staff available to work in nursing homes post-COVID (Figure 2 and Appendix Table 3). 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. WebA skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. 0000020352 00000 n rV3f2cP!aOI4XX\f3  "c:C]'5x ?(0}CP uzHq8A,7wvVSg`wg 2L@zK2(I~@Za,3X6}z` 7s endstream endobj 2476 0 obj <>/Filter/FlateDecode/Index[154 2281]/Length 67/Size 2435/Type/XRef/W[1 1 1]>>stream State Actions to Address Nursing Home Staffing During COVID-19, most likely to report a shortage of aides, staffing standards in almost every state remain severely low, must designate a full-time registered nurse as a full-time director of nursing, sufficient nursing staff to maintain the highest practicable physical, mental, and psychosocial well-being of each resident, three states have standards below this level, three states adopt the federal minimum, and 45 states have standards above the federal minimum, require a minimum number of staff hours per resident day, he primary reason that nursing homes declined to accept new residents, experiencing similar difficulty discharging patients to nursing homes due to staffing shortages, unpopular among nursing home industry representatives. A June 2021 Senior Housing News article reported that 81% of assisted living providers suffer from staffing shortages. Facilities across the country are grappling with numerous unfilled positions as a result of staff departures during the pandemic. Eric Lee for NPR 0000055058 00000 n Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. Earlier this year, the White House outlined an ambitious plan to improve the safety and quality of nursing home care, first and foremost by establishing a federal minimum staffing requirement for nursing homes funded through Medicare and Medicaid. In Baltimore, Holly Ward is a geriatric nursing assistant at a nursing home that has earned an "above average" rating for staffing from CMS. Bradley attorneys can assist with the full spectrum of healthcare regulatory and employment matters, or with any other matter that arises in the long-term care space. 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. On some days, she has as many as 13 residents to care for on a shift. 1 RN 8 consecutive hrs/7d/wk & 1 RN/LPN for 2 remaining 1 RN Day & Evening; 1 RN/LPN Night. LEARN MORE, SPONSORED BY: Innovative talent drives the aging industry forward. ", To meet Washington, D.C.'s staffing requirements, she has been working her staff "to the bones.". 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. Full Time position. (Note: For 149 beds, DON may provide direct care and be included in direct care ratios.). This RFI was a first step to facilitate a holistic approach to advancing future changes in these areas. 0000006860 00000 n she asks. Although setting minimum staffing requirements could have a positive impact on the overall quality of care and resident satisfaction, the financial impact could be devastating for some facilities. As a nonprofit, Forest Hills of DC doesn't have the bandwidth to raise wages, Sandri says. Kentucky introduced House Bill 215 on January 8, 2020, which would have increased its minimum staffing requirement. Quantitative analysis will use secondary data, including Medicare Payroll-based Journal (PBJ) data, Minimum Data Set (MDS), and Medicare claims. hb```f``[ Abl,=`4T 9J9*/p.S5UY-C[4Yi`:HF0p n_/u]'uCnx|LOhk^mpvm\5[xkVOhgsWh*@ Four of these states (AK, DE, IN, and WI) lowered the training hour requirements for CNAs during the pandemic, in efforts to address staffing issues. At least eight states adopted temporary changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes (Appendix Table 3). CMS has held listening sessions with the general public to provide information on the study and solicit additional stakeholder input on minimum staffing requirements. 0000004511 00000 n 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. Kathy Hochul lifted a three-month pause on Friday. May provide direct care and be counted in direct care ratios. hide caption. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. Helen Schaub, the unions policy and legislative director, said during the virtual news conference that the health department will view payroll based journal (PBJ) data to ensure nursing homes are complying with the laws. Based on the federal government's 5-star rating system for nursing homes from November 2022, Hawaii has the best average score (3.90 across 41 facilities), followed by Alaska (3.80, 20 facilities), Idaho (3.46, 78 facilities), Delaware (3.35, 43 facilities), and Utah (3.34, 96 facilities). WebThe Manager of an ALR must: Be at least 21 years old Have experience in administration, supervision, and management Have a Bachelor's degree or equivalent experience in human services management, housing management, or nursing home management The Manager must be of good moral character and must never have been convicted of a felony. Responses are due on June 10, 2022. As of March 27, 2022, more than one in four nursing homes nationally reported a shortage of at least one type of staff, though the share of nursing homes reporting staffing shortages varies widely by state. The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 In Takoma Park, Maurice Miller doesn't blame the staff who have left his facility in recent weeks for other jobs. Sign up to get the latest information about your choice of CMS topics in your inbox. [7] CMS has historically posted facility staffing metrics on Nursing Home Care (now known as Care Compare), such as the average number of hours worked for nursing staff per resident per day. 0000006058 00000 n If DON has institutional responsibilities, add 1 Assistant DON RN full-time. WebTwo bills passed by the New York State Legislature set minimum staffing levels in both nursing homes and hospitals. Before sharing sensitive information, make sure youre on a federal government site. Of the 3.5 hours, no less than 2.2 hours of care must Federal regulations require nursing homes to provide licensed nursing services 24 hours a day, with a registered nurse on staff for at least eight consecutive hours a day, seven days a week. Examine trends, challenges and opportunities facing clinical leaders in skilled nursing. Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. 1 DON RN full-time (1 per facility); 1 RN Charge Nurse 24hrs/7d/wk. Over the next year, policy action is expected on the federal level related to nursing home staffing. Increased adoption of automatic technologies or administrative processes such as patient intake, consent management, payment processing, and appointment scheduling, to reduce staff workload. However, the bill was voted down in the House Rules Committee four days later. Current Federal Staffing Requirements: Sufficient Numbers of all nursing staff to meet residents needs. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. 0000031136 00000 n Brooks-LaSure says her agency will determine how much staff nursing homes should be required to have and then enforce that through a rule. 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. 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. According to Genworths 2018 Cost of Care Survey, assisted Research questions will address not only what level of staffing is needed, but also the impact on quality of care,any barriers to implementation, and any potential unintended consequences of imposing minimum staffing requirements. The law requires every facility to maintain daily staffing hours equal to 3.5 hours of care per resident per day by a certified nurse aide, licensed practical nurse or registered nurse. 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. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 9 STATE STANDARD State They're burned out. However, CMS recently announced that this waiver will sunset on June 6, 2022, citing concerns about care quality. WebStaffing rates by state Overall, nursing facility staffing rates vary widely across states (Figure 1). 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.