White House Plans To Require Mandatory Nursing Home Staffing Levels May Be Derailed by CMS Report

A new federal report on the nation’s nursing homes appears to work against efforts by the Biden Administration to increase mandatory nursing home staffing levels.

The Centers for Medicare and Medicaid Services (CMS) mistakenly posted a Nursing Home Staffing Study (PDF) online Tuesday, which was quickly taken down after critics noted that the findings were inconsistent with the White House’s proposed staffing regulations announced in 2022.

The report, completed by the CMS contractor Abt Associates, warned that no mandatory staffing level could guarantee quality care in nursing homes across the United States. Researchers interviewed more than 360 nursing home staff, residents, and family members between May and December 2022. They conducted observations of more than 8,000 instances of clinical care.

Maxing out Staffing Levels Failed to Show Significant Benefits

The study examined a range of staffing hours per resident day and the impacts on patient care. The report looked at 3.88 hours per patient per day as a minimum staffing level.

At 3.88 hours, 0.66% of nursing home residents would receive delayed care, and 0.002% would not receive necessary care. That’s roughly 9,000 patients who would receive delayed care every year.

Researchers said by mandating 3.88 hours per patient, emergency room visits would be reduced by nearly 15,000 per year and hospitalizations by 12,000 per year. But to reach that level of care, 11,000 of the more than 15,000 nursing homes across the country would need to hire more staff, which could cost the industry an additional $5.3 billion per year.

The minimum level of mandated hours examined was 3.3 hours per resident per day. At that level, 3.3% of residents, or more than 46,000 people, would receive delayed care. Roughly 0.04% of patients would not receive care at all.

The findings indicate more than 50% of nursing homes would need to add staffing to meet that level of required care, and it would lead to additional costs of $1.5 billion each year.

Nursing Home Staffing Problems

A 2001 CMS study identified 4.1 hours per patient per day as a minimum staffing level. However, the new study did not examine anything near that level.

A non-government study indicated the cost of a 4.1 hour per patient standard would reach $11.7 billion annually. That standard would require nursing homes across the country to hire 200,000 new employees in addition to filling the 190,000 positions lost during the pandemic.

The February 2022 White House announcement called for reforms to improve the safety and quality of nursing home care focusing on “a sufficient number of staff who are adequately trained.”

The reforms, meant to be implemented after the findings of the newest report were published, indicated an additional 20 minutes per resident day could help reduce COVID-19 deaths by 26%. The CMS agreed to make nursing home staffing data available on the CMS Compare Care website.

Last year, a House of Representatives committee indicated nursing home understaffing led to more deaths during the COVID-19 pandemic.

The new study concluded there is “no single staffing level that would guarantee quality care.” In addition, more than half of nursing home staff interviewed for the report indicated their “current assignment was not reasonable to provide quality and safe care now.”

The findings may derail the first-ever federal mandates the Biden administration hoped to roll out, experts warned.

In 2016, a CMS report suggested that mandating staffing ratios would “stifle innovation” and would not lead to improved quality and “person-centered care.” The nursing home industry pushed back against the Biden administration’s proposed requirements, warning about substantial increases in the cost of care.

The CMS said the new study was posted in error, and it was pulled down after it was first published.

The CMS proposal package has been under evaluation by the Office of Management and Budget since May 2023.