In states such as New York, Massachusetts, and Pennsylvania – where existing mandates count LPN hours toward staffing totals – the federal proposal would introduce conflicting compliance obligations and further strain workforce planning.
Nursing, aging service orgs blast CMS for giving LPNs ‘zero credit’ in proposed staffing rule
The groups called the conspicuous absence of LPNs from proposed hourly requirements “yet another example of [the mandate’s] fundamental flaws,” and called on CMS rescind the proposed mandate entirely. LPNs make up 13% of the nursing home workforce and complete a large majority of post-acute care work in those facilities, the authors said.
“We are requesting the Administration to withdraw this archaic, unfunded health care policy and instead focus on meaningful, supportive ways to grow and retain the nursing home workforce. LPNs should be recognized and regarded with RNs as nurses — that’s what they are. This means any RN requirement should include all worked hours of LPNs in it, as both are licensed nurses. These are integral and valued members of our nursing homes, and they should be treated as such.”
— McKnight’s Long-Term Care News, November 14, 2023
‘Deeply Flawed’: LPNs Speak Out On Their Exclusion from Nursing Home Staffing Proposal
The role of licensed practical nurses (LPNs) has been chopped off from the proposal, a stipulation contested in the letter addressed to the Centers for Medicare & Medicaid Services’ (CMS) administrator, Chiquita Brooks-LaSure.
“It is evident that LPNs are essential members of a coordinated care team, [and] yet the proposed federal staffing mandate gives absolutely zero credit to the vital role they play as licensed nurses. To not include LPNs with RNs is an affront to their hard work and dedication to the residents they serve.”
— Skilled Nursing News, November 13, 2023
A new analysis reveals the harmful and costly impacts the Biden administration’s recently announced federal staffing mandates will have on Florida nursing centers and their residents. According to the study by professional services firm CLA (CliftonLarsenAllen, LLP), the federal Centers for Medicare and Medicaid Services (CMS) proposed staffing mandate will cost Florida nursing centers an additional $188 million, despite Florida already having comprehensive staffing standards. In many categories, Florida standards already exceed what is required by the federal mandate.
“The CMS proposed rule would require 2.45 nurse aide hours per resident per day (HPRD) and 0.55 registered nurse (RN) HPRD compared to Florida’s current requirement of 2.0 certified nursing assistant (CNA) hours, an additional .6 hour of direct care provided by specialty staff (may include a CNA) and 1 hour of licensed nursing services that are provided by a combined use of RNs and Licensed Practical Nurses (LPN). Under the CMS proposal, Florida centers would need to hire an additional 3,487 full time employees to meet the mandate.”
— Florida Health Care Association, October 10, 2023
LPN Exclusion in CMS Staffing Mandate a ‘Convoluted Mess’ for Nursing Homes
The skilled nursing industry is at a crossroads as it grapples with the Centers for Medicare & Medicaid Services’ (CMS) proposed federal staffing mandate. A significant point of contention in the proposal is the exclusion of licensed practical nurses (LPNs), which has ignited concerns and garnered strong reactions from industry leaders.
“Currently, the average nursing home employs 0.89 LPN hours per resident day (HPRD) and 0.26 RN HPRD. Thus, we may see a large decline in licensed staff from 1.15 (RNs plus LPNs) to 0.55 (RNs) under the proposed rule.”
— Skilled Nursing News, October 9, 2023
Disrupting an ‘ecosystem that works’: Providers rip staffing mandate’s LPN omission
In bypassing hourly requirements for LPNs, some fear the Centers for Medicare & Medicaid Services is undercutting the critical role that such shift nurses play in direct patient care.
“LPNs exist in our sector because there was a huge gap in the workforce of [registered] nurses that were willing to work in post-acute care. The LPN role has become probably 75 to 80% of the workforce in post-acute care. To eliminate them is huge. It’s huge.”
— McKnight’s Long-Term Care News, September 26, 2023
‘A Strange Rule’: Policy Experts Call for Changes, Compromise to Staffing Proposal for Nursing Homes
Leaders from across the sector – nurses and policy experts – are urging lawmakers to more carefully consider some of the stipulations of the nursing home staffing proposal, including the ratios of direct care staff, timing and even financial factors that may ultimately prevent the industry from complying with its conditions.
“It’s a little bit of a strange rule. [Of] the three direct care staff types in a nursing home, two of them now have a number that [federal authorities] say that nursing homes have to step up to the other one, which was completely ignored in the legislation.”
— Skilled Nursing News, September 21, 2023
CMS ‘naive’ about staffing minimum proposal details, professor claims
Charlene Harrington, RN, PhD, professor emeritus at the University of California-San Francisco School of Nursing, sharply criticized the proposed federal mandate for not going far enough during the webinar presented by the Long-Term Care Community Coalition.
“They are more likely to reduce overall LPN staffing [since] there is no minimum requirement for that,” she said, adding that the phase-in period to be in compliance is “ridiculously long.”
— McKnight’s Long-Term Care News, September 20, 2023
A slap in the face for LPNs who keep nursing homes running
The rule has the potential to change nearly everything about the skilled nursing workforce, from the total time direct care staff spend with patients to the oversight and hands-on care provided by a lot more registered nurses.
“According to the Bureau of Labor Statistics, 35% of the 655,000 LPN roles in the US last year were in nursing and residential care facilities. Of those, only about 56,000 are working in assisted living or similar facilities. So that leaves about 175,000 LPNs in nursing homes — critical staff members who might no longer fit into the SNF job market if the proposed rule is finalized as currently written.”
— McKnight’s Long-Term Care News, September 19, 2023
