Most nursing homes in the United States will have to add staff under a federal rule announced Monday that, for the first time, sets minimum staffing ratios nationwide for homes that care for the elderly and disabled.
The rule, announced Monday by Vice President Kamala Harris, requires nursing homes to meet minimum staffing requirements for registered nurses and nursing assistants. The rule aims to limit cases of resident neglect or delays in care, a persistent problem that was exposed when more than 200,000 nursing home residents and staff died from COVID-19 in the first two years of the pandemic. .
Experts say the rule is an important step in strengthening the quality and safety of nursing homes.
This is the most important nursing home reform in decades, said David Grabowski, a professor of health care policy at Harvard Medical School. We need more staff in nursing homes. This is a huge development in terms of setting a floor so that nursing homes can’t be too short on facilities.
Mark Parkinson, president and CEO of the nursing home industry group American Health Care Association, criticized the rule as “unconscionable” given the nation’s nursing shortage.
“Issuing a final rule that requires hundreds of thousands of additional caregivers when there is a shortage of nurses across the country only creates an impossible task for providers,” Parkinson said in a statement. “This unfunded mandate does not magically solve the nursing crisis.”
The White House said in a fact sheet that the new rule requires all nursing homes that receive federal funding through Medicare and Medicaid to provide staffing equivalent to about 3.5 hours of daily care for each resident . The rule also requires nursing homes to have registered nurses on duty 24 hours a day, seven days a week to “provide skilled nursing care, which will further enhance the safety of nursing homes.”
On average, a nursing home with 100 residents would have two to three registered nurses and at least 10 nursing assistants on duty for each shift throughout the day. Officials said this level of staffing is necessary to provide safe care with good outcomes for vulnerable residents.
US Health and Human Services Secretary Xavier Becerra told USA TODAY on Monday that these staffing requirements represent the minimum level of care for more than 1.2 million Americans in certified nursing homes federally
“If you represent yourself to be a nursing home, you should have a nurse available to take care of my loved one that I’m about to put into your facility,” Becerra said. “We insist that the care you provide must be of quality.”
It’s a level of care that any family member would expect, he said.
The Biden administration said the rule would be implemented in phases to give nursing homes, especially those in rural communities, time to hire the additional workers. Nursing homes must complete an assessment that assesses the daily needs of residents within 90 days of the end of the rule. Minimum staffing levels will be established in two to three years.
Nursing homes in communities facing labor shortages will have “limited and temporary waivers” to meet registered nursing requirements and general staffing ratios, the White House said.
Federal researchers and academics have long established staffing levels as the best predictor of quality nursing home care. However, the Centers for Medicare and Medicaid Services, which regulate nursing homes that receive funding from Medicare and Medicaid, have never required a specific number of nurses and aides. . The agency has only made recommendations that few facilities have followed.
In a related rule also announced Monday, the Biden administration seeks to strengthen home care for seniors and disabled residents of Medicaid, the federal health program for low-income populations. The rule requires companies that provide home care services to spend a minimum of 80% of Medicaid payments on workers’ wages.
The Biden administration said higher wages for home health workers would reduce turnover and lead to higher quality home care for the elderly and disabled.
Home health workers “can sometimes find a better-paying job flipping hamburgers than giving your loved one the care they need,” Becerra said. “We need to do more.”
The home care rule, which is similar to the nursing home staffing ratio rule, would allow states to take into account “the unique experiences faced by small home care providers and suppliers in rural areas” to meet those requirements, the White House said.
AUSA TODAY’s investigation found that while nursing homes have submitted daily staffing data to federal officials for years, they have rarely been punished for violating existing guidelines and rules.
Such penalties have been unusual even at facilities where inspectors noted understaffing in the course of investigating preventable deaths and people who had suffered broken bones spent days without help getting up from the bed or hours sitting on stool, among other violations. Fines for such violations have been even rarer.
Contributor: Jayme Fraser
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