The Biden Administration has proposed new minimum staffing requirements that will require nursing homes to have a registered nurse on site 24/7 and to provide three hours of care per resident per day.
The federal Department of Health and Human Services, which announced the proposed rules last week, is stipulating that out of the three hours of required care per resident, per day, 0.55 hours must come from registered nurses.
According to an estimate from the Centers for Medicare & Medicaid Services, nearly three quarters of the estimated 15,500 nursing homes in the US will need to increase staffing in their facilities to comply with the new staffing minimum, which is the first update in federal nursing home staffing regulations since 1987.
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The new staffing requirement comes in the midst of a severe national nursing shortage that began before the pandemic and was exacerbated by the Great Resignation. Despite occupancy levels that are now over 80%, nursing home operators are seeing margins squeezed by rising costs and labor shortages.
When HHS announced last year that it was planning to unveil new minimum staffing levels, the government was widely expected to propose the recommendation from a landmark study in 2001 which called for 4.1 hours of nursing care per resident per day.
However, a new CMS-funded study, which was released in draft form last week and reported by KFF Health News, found there was "no obvious plateau at which quality and safety are maximized, or cliff below which quality and safety steeply decline." The CMS study made no specific recommendation for staffing minimums, the report said.
Following the KFF report, CMS retracted the new report from the CMS website, indicating it had been published in error.
Mark Parkinson, CEO of the American Health Care Association (AHCA) said in a statement that the decision to move forward with the staffing minimum was "unfathomable" in light of the new CMS report.
"Especially, when just days ago, we learned that CMS' own study found that there is no single staffing level that would guarantee quality care," Parkinson said.
The new rules "requires nursing homes to hire tens of thousands of nurses that are simply not there," Parkinson said, in a statement. "It then penalizes us and threatens to displace hundreds of thousands of residents when we can't achieve the impossible."
Based on the 2001 recommendation of 4.1 hours of minimum care the AHCA estimated in December that a 4.1-hour standard would cost nursing home operators $11.3B annually and require an additional 191K nurses and nurse aides.
According to the AHCA report, 94% of the nation's 15.500 nursing homes currently would be unable to comply with a 4.1-hours-per-resident-day standard of care due to inadequate staffing.
The report also said that up to 450,000 nursing home residents could be at risk of displacement if skilled nursing facilities that are unable to scale up their staffing and therefore may need to reduce the number of residents.
The AHCA estimate was prepared in tandem with accounting and consulting firm CliftonLarson Allen (CLA). Despite increasing occupancy levels at nursing homes, a separate CLA report found in December that nearly 60% of skilled nursing facilities were operating with negative margins.
"The additional burden of meeting minimum staffing requirements with no funding mechanism will potentially increase the number of facilities operating with negative margins," said Deb Emerson, principal of CLA, in a statement.
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