Nursing Home Staffing Rules Finalized, Require More Nurses and Aides

The Biden administration has finalized new nursing home staffing rules that will require thousands of facilities to hire more nurses and aides. The rules aim to address staffing shortages that have been linked to poor care and high rates of preventable harm. However, some patient advocates say the rules do not go far enough to ensure high-quality care. The new rules will require most nursing homes to provide an average of at least 3.48 hours of daily care per resident, including at least 0.55 hours of RN care and 2.45 hours from aides. The rules also mandate that an RN must be on duty at all times in case of a patient crisis on weekends or overnight. Nursing homes in rural areas will have longer to comply with the new staffing requirements. The American Health Care Association, which represents the nursing home industry, has called the regulation “an unreasonable standard” that “creates an impossible task for providers” amid a persistent worker shortage. However, labor unions representing nurses have welcomed the rules, calling them a “long-overdue sea change.” Advocates for nursing home residents have been pressing for higher staffing standards for years, and some say the new rules do not go far enough. A CMS-commissioned study found that the quality of care improved with increases of staff up to a level of 4.1 hours per resident per day — nearly a fifth higher than what CMS will require. The consultants CMS hired in preparing its new rules acknowledged the earlier findings in their evaluation of options. CMS said the levels it endorsed were more financially feasible for homes, but that assertion didn’t quiet the ongoing battle about how many people are willing to work in homes at current wages and how financially strained homes owners actually are. “If states do not increase Medicaid payments to nursing homes, facilities are going to close,” said John Bowblis, an economics professor and research fellow with the Scripps Gerontology Center at Miami University. “There aren’t enough workers and there are shortages everywhere. When you have a 3% to 4% unemployment rate, where are you going to get people to work in nursing homes?” Researchers, however, have been skeptical that all nursing homes are as broke as the industry claims or as their books show. A study by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors. Charlene Harrington, a professor emeritus at the nursing school of the University of California-San Francisco, said: “In their unchecked quest for profits, the nursing home industry has created its own problems by not paying adequate wages and benefits and setting heavy nursing workloads that cause neglect and harm to residents and create an unsatisfactory and stressful work environment.”