CMS Sparks Concern with Unfunded Proposal for 4.1 Hours per SNF Resident Minimum Staffing Level

Minimum Staffing

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The Centers for Medicare and Medicaid Services are proposing minimum staffing requirements for skilled nursing facilities. CMS began the process of implementing a minimum staffing standard across SNFs back in April, 2022. According to this requirement, nursing homes need to have sufficient staffing in order for every resident to receive a minimum amount of direct care everyday. 

The Importance of Staffing in Nursing Homes

Adequate staffing in nursing homes benefits the residents in a number of ways. Studies back the correlation between higher staffing levels and better quality of care. Increased staffing levels resulted in fewer deaths from Covid-19. On the other hand, poorly staffed nursing homes fared far worse, in terms of abuse, health inspections and overall ratings compared to staffed nursing homes. 

According to federal regulations, nursing homes must have “sufficient staff” for nursing services and catering to the needs of residents in ways that support their well-being. This sufficiency standard has led to varying degrees of staffing across facilities and the level of direct care each resident receives. 

The Proposed Staffing Standard Across SNFs

According to a 2001 CMS study, residents in nursing homes need 4.1 hours of direct nursing care to limit additional risks. The study further highlighted the breakdown of those hours: residents on a daily basis require .75 hours of direct care by the Registered Nurse, .55 hours by a Licensed Practical Nurse, and 2.8 hours of care provided by the Certified Nursing Assistant. 

Regardless of an adequate baseline, CMS needs to work together and pull resident acuity into this minimum staffing standard. Resident needs vary as some of them need more hours of direct care in a single day. Therefore, it is important that this proposed standard of care takes into account resident acuity, as this will help save lives and lead to better health outcomes for residents in SNFs across the United States. 

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Minimum Staffing Requirements: the Counter-Argument? 

Over 200,000 residents face the risk of being displaced from their current skilled nursing locations if U.S federal leaders decide to enforce minimum staffing requirements across SNFs. As mentioned in a report by the American Health Association, nursing homes would be spending $10 billion per year and hiring 188,000 nurses in order to cope with the proposed increased minimum staffing requirements. 

The proposal for minimum staffing requirements has been pushed forward by the Biden administration, in order to ensure that residents get the highest quality of care at nursing homes. On the other hand, major healthcare stakeholders worry that complying with these proposed standards is the real challenge, as nursing homes suffering  significant staffing shortages have no easy opportunities to meet the standard. 

To sum it all up, it would cost SNFs a great deal annually, in terms of incremental spending to hire additional staff members, in order to meet proposed staffing standards of 4.1 resident hours per day. 

According to Mark Parkinson (President and Chief Executive Officer at AHCA (American Health Care Association), 

This report makes it crystal clear that increasing staffing standards in nursing homes requires substantial and consistent government resources. Even then, nursing homes would have the impossible task of finding another 187,000 nurses at a time when vacant positions sit open without applicants for months on end.”

These unfunded minimum staffing levels could come as a heavy blow to seniors who might lose access to vital care services. In addition to this, the mandate falls short of providing support for building a team of new caregivers, such as developing supporting/training programs. Labor shortages already exist alongside chronic Medicaid underfunding, and so this given mandate will only exacerbate current challenges. This unfunded mandate will affect not only staff across SNFs, but will put thousands of vulnerable nursing residents at risk of being forced out of the nursing facility. 

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In case the Biden administration decides to go forward with a federal minimum staffing requirement, there will be a greater possibility of nursing homes limiting the number of residents they provide care for in their attempts to comply with this. 

The Biden Administration Vows to Reform Nursing Home Care! 

One example of a resident, Maurice Miller at a nursing home in Takoma Park, highlights structural inconsistencies that continue to exist in SNFs across the U.S. Maurice has both good and bad days at the nursing home. While he is taken care of on the good days, it might take the staff a little longer to answer his call button, sometimes 45 minutes or more on a bad day. Miller realizes the underlying problem: the facility is under-staffed as there are less than five nursing assistants taking care of the 50 or more residents.

Stories like these have led the Biden administration to push for major reforms across nursing homes. The White House put forward an ambitious plan earlier this year, to ensure greater quality of nursing care by establishing a federal minimum staffing requirement for nursing homes. 

In the words of Chiquita Brooks-LaSure (Administrator for the Centers for Medicare and Medicaid Services), 

We think it’s really important to set a very specific standard that can be measured against, to really make sure staff is adequate to ensure quality.” 

While nursing homes in Washington, D.C have taken to adopting the federal government’s guidance on 4.1 hours of direct care: several challenges continue to plague nursing homes. 

Turnover and burnout across nursing facilities is actively on the rise. Most facilities across the U.S do not have the capacity to increase wages, as they receive most of their funding from Medicare and Medicaid. 

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In order to assure compliance with this new proposed standard, the federal government must raise the level of its direct funding for nursing home care.

In case you missed the previous blog on
Top 5 Learnings From LTC 100:


Why do nursing homes need a minimum staffing standard? 

Minimum Staffing Requirements Could Cost Nursing Homes $10B Annually

Nursing home residents suffer from staffing shortages, but the jobs are hard to fill

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