Proposed Nursing Home Minimum Staffing Reforms Face Opposition from Nursing Home Industry

The Biden Administration has proposed reforms to the nation’s nursing home laws and regulations, including those related to minimum staffing requirements. Under President Joe Biden’s direction, the Centers for Medicare and Medicaid Services (CMS) has studied the connection between low nursing home staff levels and nursing home accidents, abuse, or neglect. The common consensus, as it has been for decades now, is that a nursing home with insufficient staffing is much more likely to injure an elderly resident, either intentionally or unintentionally. Using the results from its study, the CMS has announced a series of proposed nursing home regulation reforms focused on correcting the understaffing issue that troubles approximately 75% of all nursing homes across the country.

Under the new proposals, which are not recognized laws or regulations yet, nursing homes would need to:

  • Hire additional staff to “meet minimum levels.”
  • Ensure nursing staff levels amount to no less than 0.55 hours per resident per day.
  • Schedule 2.45 nurse aide hours per resident per day (hire about one aide for every 10 residents).
  • Always keep a registered nurse on duty (24/7/365).
  • Prove that there is a local hiring shortage if additional staff are not hired in a timely manner.

However, every issue has two sides, and so the nationwide nursing home industry has been ready to challenge the proposal the moment it was first announced. Specifically, nursing home companies and related groups have stated that Medicaid reimbursement rates are too low, which causes some nursing homes to be underfunded and unable to hire more staff members. The COVID-19 pandemic saw a massive spike in nursing home deaths but also a dramatic decrease in nursing home staffing, so the need to hire more staff has never been higher while the ability to find workers has rarely been lower.

One nursing home group, LeadingAge, has stated that Medicaid needs to do more to cover the cost of additional staff. Currently, Medicaid programs pay about 86 cents per dollar to assisted living centers that qualify for federal aid. LeadingAge wants to see that amount increase to 95 cents per dollar before it believes that the understaffing crisis could be solved. Other groups have said that a forced requirement to hire more staff without higher Medicaid funding could result in thousands of nursing homes being forced to close their doors.

A leading counterargument against the nursing home industry’s stance is not that workers can’t be found but that workers can’t find valuable employment. It is argued that profitable nursing homes could hire the necessary additional staff if they were willing to provide higher wages and better benefits.

Vague Rules Have Lasted for Decades

The last time the nursing home staffing regulations were examined and updated was in 1987. Advocates for a new set of proposed regulations say that the rules are not just outdated being decades old but that they have also been vague and too lenient the entire time.

Currently, federal laws require most nursing home facilities to provide 24-hour licensed nursing services that are “sufficient” compared to the needs of the residents there. A registered nurse must also be on staff for an 8-hour shift each day. Critics point to studies that show each nursing home resident should have more than 4 hours of direct care from a registered nurse each day to maintain optimal physical and mental health needs, which would require far more than just 8 total hours of nursing home staff time per day. Also, critics argue that “sufficient” is a vague word that has allowed nursing home companies to understaff their nursing homes without consequences. In many nursing homes, it is known that a single nursing staff member must attend to at least 20 residents each day.

Will the Proposed CMS Rules Stick?

The CMS’s proposed updates to the nation’s nursing home staffing regulations do not include additional funding for nursing homes to hire more nurses and nursing aides. Opponents of the proposal argue that more federal funding is a must, yet it doesn’t seem like the CMS will back down from these new potential regulations. A press release from the CMS states, “The federal minimum staffing standards proposed by CMS are robust yet achievable. The proposal also makes it clear that the numerical staffing levels are a floor – not a ceiling – for safe staffing.”

At Brown & Barron, our mission has always been to protect the rights of the wrongfully injured with an intentional focus on nursing home abuse and neglect cases. We are paying close attention to the newly proposed regulations for the CMS and how they could potentially make nursing home living safer for many thousands of elderly nursing home residents. Please visit our blog often for any important updates to this story.

If you are worried that your elderly loved one has been abused or neglected in a Maryland nursing home, please contact Brown & Barron today. We may be able to uncover evidence of the unacceptable treatment and start a claim to pursue justice and compensation. Call (410) 698-1717 for more information.

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