Because PBJ data is the primary tool CMS will use to assess compliance with the proposed 0.55 RN and 2.45 nurse aide HPRD thresholds, accurate and consistent payroll reporting is essential for SNFs gauging their exposure to penalties, citations, and survey consequences.
The U.S. News & World Report’s 2024 Best Nursing Homes ratings released Tuesday reveals that fewer than 5% of nursing homes across the country will meet both the current federal staffing requirements and the newly proposed standards by the Biden administration.
— Skilled Nursing News, November 14, 2023
Even though the staffing mandate proposed by the Centers for Medicare & Medicaid Services directly would apply only to nursing homes, senior living providers as well as providers across the rest of the aging services continuum would be affected because they are “fishing from the same pool” of workers, LeadingAge President and CEO Katie Smith Sloan said Monday.
“There are just not enough people to hire,” Sloan said. The CEO said that the proposed standard for nursing homes, as written, would require 90,000 additional nurses and nurse aides at a cost of approximately $7.1 billion annually.
— McKnight’s Senior Living, November 7, 2023
Analysis Reveals the Effects the CMS Staffing Proposal Would Have on Nursing Homes
KFF, an independent source for health policy research, polling, and journalism, has released a brief examining the share of nursing facilities that might meet the proposed new staffing requirement. Alice Burns, associate director of KFF’s Program on Medicaid and the Uninsured, sat down with iAdvance Senior Care to discuss the brief and what its findings mean for the nursing home industry.
According to the brief, approximately 19% of nursing facilities would currently meet the minimum RN and nurse aide staffing requirements, while 81% of facilities would need to hire more RNs or nurse aides. Only 28% of facilities meet the nurse aide requirement, but nearly half of facilities meet the RN requirement.
— iAdvance Senior Care, November 6, 2023
Unfunded Mandate Leaves Staffing ‘Puzzle’ Unsolved: Researchers
In the short term, Harvard healthcare policy expert David Grabowski, PhD, and Scripps Gerontology Center Fellow John Bowblis (pictured), PhD, urged the Centers for Medicare & Medicaid Services to use a total nurse-hour measure to ensure that licensed practical nurses remain a core component of daily nursing home care.
“Without addressing broader reform, including payment reform and developing a strong long-term care workforce, the1 proposal as written can lead to a number of nursing home closures, especially in states where staffing levels are lower and Medicaid payment rates already do not cover the cost of care.”
— McKnight’s Long-Term Care News, November 1, 2023
Nursing Home Shortages ‘Biggest Public Policy Issue’ for State, Nation: Virginia Provider Exec
As the threat of a federal mandate inches closer to reality, nursing homes in Virginia are reporting major difficulties finding qualified staff.
A recent survey from the Virginia Health Care Association/Virginia Center for Assisted Living of its members found that 31% of respondents said they had “few to no applicants” for open positions. And 91% of respondents said they have vacancies for certified nursing assistants — a role that makes up a significant part of the recently proposed federal staffing mandate.
— McKnight’s Long-Term Care News, November 1, 2023
Federal Mandate for Nursing Staff ‘Undermines Access to Care’
In its inexplicable efforts to resurrect what the Obama Administration rejected, the Biden Administration commissioned a study finding no “clear evidence basis for setting a minimum staffing level” and warning “nursing homes are currently very challenged in hiring and retaining direct care workers, because of workforce shortages and competition from higher-paying agency positions.”
Our two senators signed a bipartisan letter stating “a one-size-fits-all staffing mandate significantly undermines access to care for patients, particularly in rural communities.”
— NH Business Review, October 23, 2023
Nate Schema, CEO with the Evangelical Lutheran Good Samaritan Society, says the organization’s facilities located in “deep rural communities” will struggle the most with the 24-hour RN rule.
“Especially for us Midwest folks, it’s like the sirens are going off. The tornado is coming, you don’t know where it’s going to land. But when it lands, it can wipe out a community,” he said.
— Skilled Nursing News, October 17, 2023
In particular, providers are mobilizing to hire more RNs or training licensed practical nurses (LPNs) for the role, executives at regional and national nursing home chains said at Skilled Nursing News’ recent RETHINK conference in Chicago.
“But what we really want to do is just keep the pedal to the metal with hiring RNs and trying to source and retain,” Haug said. “And, we really have shifted a lot on developing our LPNs.”
— Skilled Nursing News, October 16, 2023
The “clinical nightmare” created by Covid-19 has come to an end, but the “business nightmare” related to the pandemic is ongoing, and the “policy nightmare” has only just begun.
“The proposed staffing rule is an overreaction — a poor reaction to a horrible crisis that we all experienced.” He reiterated that the requirement is impossible to implement due to lack of available workers and lack of funding.
— Skilled Nursing News, October 2, 2023
First State Analysis Shows Mass Closures Under ‘Catastrophic’ Federal Staffing Proposal
The Health Care Association of Michigan surveyed its members and accessed facility statistics through the American Health Care Association’s LTC Tracker to find that 71% of facilities in the state would not meet the proposed staffing rule for certified nurse aides. In addition, 41% of facilities would not be able to meet the requirement to provide 0.55 hours of direct care by a registered nurse and “almost no” facilities are capable of having an RN on duty 24/7.
“The impact on the sector, if this was implemented today, would be catastrophic,” said Melissa Samuel, president of the Health Care Association of Michigan. The analysis found that 71% of facilities in the state would not meet the proposed staffing rule for certified nurse aides, and “almost no” facilities are capable of having an RN on duty 24/7.
— McKnight’s Long-Term Care News, September 26, 2023
What Share of Nursing Facilities Might Meet Proposed New Requirements for Nursing Staff Hours?
…This issue brief analyzes the percentage and characteristics of facilities that would meet the rule’s proposed requirements for the minimum number of RN and nurse aide hours to better understand the implications of the rule. The analysis does not evaluate facilities’ ability to comply with other requirements, including the requirement to always have a registered nurse on duty 24/7 or the ability to meet the new reporting and assessment requirements due to data limitations (see methods). The analysis uses Nursing Home Compare data, which include 14,591 nursing facilities (97% of all facilities, serving 1.17 million or 98% of all residents) that reported staffing levels in August 2023.
Among all nursing facilities, fewer than 1 in 5 could currently meet the required number of hours for registered nurses and nurse aides, which means over 80% of facilities would need to hire nursing staff. 90% of for-profit facilities would need to hire additional nursing staff compared with 60% of non-profit and government facilities.
— KFF, September 18, 2023
KFF: Fewer Than One in Five Nursing Homes Could Meet Federal Staffing Proposal
Fewer than one in five facilities would currently meet the required number of hours for RNs and CNAs as set forth in the federal minimum staffing proposal, with more than 80% of the facilities nationwide needing to hire more nursing staff.
“The proposal raises very real challenges for the whole health care sector, and actually jeopardizes access to care for older Americans. No state will be immune from the harm,” said Katie Smith Sloan, president and CEO of LeadingAge.
— Skilled Nursing News, September 18, 2023
Nearly 450K Residents at Risk of Displacement if Mandate is Enacted, As Access Issues Compound
As nursing homes limit admissions due to ongoing labor challenges, residents can expect a mounting access crisis, with some U.S. counties being turned into “nursing home deserts.”
Nearly 450,000 residents will be displaced if a potential minimum staffing mandate were to be enacted. From 2020 to the present, 579 nursing homes have closed, and more than 21,000 residents have been displaced by closures. Moreover, 30 additional counties have become what AHCA calls “nursing home deserts.”
— Skilled Nursing News, August 23, 2023
Analysis Warns Few Nursing Homes Could Now Meet 3.5 Staffing Hours Per Day
A national analysis finds that nearly half of US nursing homes would not meet a daily, 3.5-hour nurse staffing requirement and just 29% would meet a standard of 4.0 hours.
The work from KFF exposes the challenge that nursing homes will have if the long-anticipated federal staffing mandate from the Centers for Medicare & Medicaid Services requires 4.1 hours of direct care per resident per day, as some sector observers have predicted.
— McKnight’s Long-Term Care News, July 17, 2023
KFF: Only 29% of Nursing Homes Would Meet 4-Hour Federal Staffing Mandate
A KFF analysis released Friday suggests that less than a third of the nation’s nursing homes would even come close to meeting forthcoming minimum staffing requirements. Close to half, or 45% of SNFs say they could not meet a 3.5 HPRD requirement, and only 29% would meet 4.0 HPRD.
— Skilled Nursing News, July 14, 2023
