Most long-term care facilities in Missouri will need to hire more nursing staff to meet new federal requirements the Centers for Medicare and Medicaid Services announced this week.
Under the new rule, homes receiving federal funding must have a nursing staff that could include registered nurses, licensed practical nurses and nursing assistants to cover about 3 hours of care per resident per day. The new rules also require a registered nurse to be on staff 24 hours a day.
A 100-bed nursing home would need more than a dozen nursing staff available per shift, explained Priya Chidambaram, a Medicaid policy expert at KFF, a national health policy research organization.
Which translates to a facility with about a hundred residents with two or three RNs and 10-11 nursing assistants and a couple other nursing staff per shift, Chidambaram said.
According to federal data, only 11 percent of homes in the state currently meet the new standards, he said.
Worker and patient safety advocates in Missouri largely supported the regulations, but landlords and industry group representatives said the new rule created unrealistic standards for an industry already struggling to hire and retain employees.
We’ve struggled to get RNs, said Kerri Lauterbach, CEO of Beth Haven, a 105-bed retirement home in Hannibal. Trying to get RNs in the door for a 24 hour requirement seems almost impossible.
Long-term care facilities have up to five years to comply with the new standards, with rural facilities taking longer to comply. The rollout gradually increases the requirements, with minimum nurse staffing standards starting before requirements on the proportion of each type of nurse needed.
Facilities receiving Medicaid reimbursement must comply. If not, they face fines or risk losing their funding. A facility could receive an exemption from the rule if its owners demonstrate that they have made good faith efforts to hire enough workers, according to CMS.
I wouldn’t be opposed to having an RN around the clock; that would be great. But right now there are too many challenges to make it happen,” Lauterbach said.
He added that the requirement that an RN be on site at all times increases the perception that these facilities are unsafe.
Nurses can also make more money by doing less demanding tasks while working elsewhere, said Bill Bates, CEO of LeadingAge Missouri, an industry association that represents mostly nonprofit facilities.
Hospitals that also need nurses pay more for lighter work than what’s often found in a long-term nursing home where the work is tough, she said.
Missouri ranks second to last in the nation in the hours nursing home residents receive per day from nurses, according to an analysis by the Long Term Care Community Coalition.
Patient advocates say the new rules will increase the state’s health and safety for more than 34,000 residents who live in nursing facilities.
It’s about making sure residents get hands-on care, because that’s everything, from insulin testing [to medication giving and checking to see if somebody is having an episode with one of their health conditions, said Marjorie Moore, executive director of VOYCE, a group that advocates for nursing homes residents and their families. But this is also things like taking residents to the bathroom and helping them eat and getting them out of bed.
But the nursing home industry has a lot of work to do to make sure there are enough nurses and assistants trained to fill required jobs, Moore said.
The federal government has set aside $75 million to launch a national nursing home staffing campaign to increase the number of nurses in nursing homes.
Staffing requirements will keep more people on the job, said Lenny Jones, state director of the Service Employees International Union, which represents nursing home workers.
Low staffing leads to incredible staffing turnover, he said. Somebody comes on board and sees what the duties of their job are and [that] they can’t provide the care they want to provide to residents because they are so understaffed. There are so many demands on them and they gave up.
The Missouri Department of Health and Senior Services inspects more than 1,000 nursing homes annually. About 500 of them receive funding from Medicare and Medicaid.
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