CMS Proposed Nursing Home Staffing Standards Have Received 40k Public Comments

Federal regulators have received tens of thousands public comments in response to regulations proposed by the Biden Administration and the Centers for Medicare & Medicaid Services (CMS), which would require mandatory increases in nursing home staffing levels at facilities throughout the U.S.

Skilled Nursing News released a report on November 6, indicating that CMS received comments from at least 40,000 individuals, both in favor of and in opposition to, proposed rules that would implement and enforce minimum staffing and care requirements for individuals in nursing homes or long-term care facilities.

The proposed rules were introduced to address concerns over inadequate care that results from nursing home understaffing, and CMS accepted public comments on the reform policies for a period of 60 days, so that officials can review any additional medical, technical, or scientific evidence before making a final determination.

Understaffed Nursing Home Risks

Recent research has shown insufficient staffing and frequent staffing turnover in nursing homes reduces the quality of care patients receive, and may increase the risk of injuries. Researchers indicate even a 10% increase in staff turnover can decrease the quality of care patients receive and reduce their functioning.

An investigation led by a panel of U.S. lawmakers indicated that shortages of nurses and certified nursing aides (CNAs) in nursing homes was a major contributing factor of COVID-19 deaths and poor health outcomes for residents during the pandemic. The Government Accountability Office found that more than 200,000 nursing home deaths were reported throughout the course of the pandemic, due to poor quality of care and neglect from insufficient staffing.

A study conducted by the American Health Care Association (AHCA) revealed that more than 73% of U.S. nursing homes reported they were at risk of closing due to insufficient staffing stemming from the COVID-19 pandemic. The study also found that approximately 60% of the participating nursing homes reported moderate or high staff shortages, and at least 98% reported difficulty hiring staff.

Proposed Nursing Home Staffing Standards

A series of nursing home staffing reform policies were introduced in February 2022, in an effort to ensure residents receive quality care by establishing a minimum staffing requirement, reducing the amount of residents placed in shared rooms, and providing incentives to facilities that maintained adequate staffing and provided quality care.

The proposed nursing home staffing rules would require a registered nurse to be on site 24/7, and facilities would need to provide each resident with at least 0.55 hours of care from a registered nurse, and at least 2.45 hours of care from a nurse aide each day. If implemented, non-rural nursing homes would have 3 years to meet the new minimum standards, and rural facilities would have 5 years.

Other improvements would include better enforcement of existing staffing standards, review of nursing home spending of taxpayer funds, inappropriate medication prescriptions, and enhance emergency planning. The government would also help recruit, train, and retain nursing home staff by investing more than $75 million in scholarships and tuition reimbursement.

Response to Proposed Nursing Home Policies

In response to the proposed staffing mandate, Skilled Nursing News reported some commenters were in support of the minimum staffing proposal and noted the actions are well intended, however, the plan received resistance from many in the nursing home industry.

Many commenters were concerned about facilities being able to meet the minimum staffing requirements, due to lack of funding and lack of qualified medical staff. One commented that there are not enough registered nurses in supply, and some areas do not have any nurses available to meet the proposed standards.

Others were concerned over being able to afford the additional expenses necessary to implement the rulings. Nursing home industry commenters claimed many facilities may have to close due to the financial restraints, especially those in smaller, more rural communities, displacing the residents that depend on their long-term care.

AHCA members alone submitted 14,000 comments to the CMS. The association formerly requested officials revoke the mandate on their final comment submitted on November 7, claiming nearly 300,000 residents are at risk of being displaced from nursing homes if the proposal is approved. Some nursing homes will be forced to downsize or close as a result of the requirements, AHCA commenters claim.

The Pennsylvania Health Care Association submitted documentation of its own plan implemented on July 1, 2023, meant to improve general nursing care by increasing the daily amount of required resident care from 2.7 hours to 3.2 hours, and incrementally increasing ratios of registered nurses, licensed practical nurses, and certified nursing aides over a period of two years. However, the association questioned the federal proposals, indicating providers are struggling to find qualified workers, and maintain operations with increased wages and staff.

The CMS must now review the 40,000 comments to include any additional information or evidence it may have received before making a final decision on the matter, which may take as long as a year to complete.