If the mandate is finalized, operators of all sizes should assess their current staffing ratios and begin workforce planning against the proposed minimums.
Not everyone is happy about the staffing mandate’s repeal
Well, as it happens, not everyone is doing a happy dance.
The Long Term Care Community Coalition was quick to voice its dismay, calling the repeal a step backward for resident safety. The group warned that as a result, residents will wait longer for meals, bathing, pain management and supervision.
The coalition also pointed to what it called a deeper systemic problem: chronic understaffing, driven by high turnover, low pay and grueling working conditions. Rolling back federal standards won’t fix any of that; it will simply leave residents and overworked staff to absorb the consequences, the coalition insisted.
The varied reaction here probably tells you everything you need to know about a major divide in long-term care: In one camp, we have operators insisting they are doing the best job humanly possible, given the circumstances. In the other camp are disgruntled advocates who insist the product being delivered is far from adequate.
— McKnight’s Long-Term Care News, December 7, 2023
Groups of US Senators and Attorneys General Defend Proposed Staffing Rule
Fifteen state attorneys general and 12 US senators submitted separate group letters strongly supporting the proposed nursing home staffing mandate.
The AGs’ letter went further — advocating for tightening regulation loopholes and for even higher hours per resident day requirements, noting that the proposal’s 3.0 total nursing hours per day still falls short of a 4.1 HPRD benchmark set by a peer-reviewed, CMS-commissioned study. Senators also urged CMS to include LPNs in the final rule, calling them “critical to the operation of America’s nursing homes.”
— McKnight’s Long-Term Care News, November 9, 2023
CMS Official: Nursing Home Staffing Mandate ‘Balanced and Achievable,’ Stakeholder Comments Valued
More than a month after the announcement of the federal minimum staffing proposal, an official with Centers for Medicare & Medicaid Services (CMS) reinforced the agency’s commitment to the rule and urged providers and other stakeholders to continue submitting comments on the matter by Nov. 6.
Dr. Dora Hughes, acting CMS Chief Medical Officer, reinforced the agency’s commitment to the rule during a quarterly stakeholder call, stating the proposals “are balanced and achievable” while acknowledging challenges for rural facilities. CMS had already received more than 7,000 public comments on the proposal by mid-October, with the comment window set to close November 6. Ongoing comments from facility operators raised consistent themes: LPN exclusion, rural feasibility, and the need for more funding support.
— Skilled Nursing News, October 17, 2023
CMS Gets It Right: Individuals Receiving Care Will Benefit from RN Staffing Mandate
Nancy Haugen, RN, president of Elder Voice Advocates, argues that RN-level education and scope of practice are meaningfully distinct from LPN roles — encompassing comprehensive assessment, care plan development, and supervisory responsibility — and that increasing RN presence in long-term care will directly improve resident outcomes. She notes that working conditions and compensation must also improve to attract more RNs to the sector, and that providers may need to scale back profit expectations to make that happen.
— McKnight’s Long-Term Care News, October 16, 2023
Proposed Minimum Staffing Requirements Poised to Impact Nursing Homes
Reactions to the rule were mixed. AHCA president Mark Parkinson called it an “unfunded mandate” that would worsen workforce shortages, while LTCCC executive director Richard Mollot said the proposal “falls far short” of what the President had promised — noting that only nursing homes at the very bottom of staffing performance would feel significant pressure to change. Under the rule as proposed, 22% of nursing homes would need to add RNs and 68% would need to add nurse aides to meet minimum thresholds.
— I Advance Senior Care, October 4, 2023
24-Hour Registered Nurses in Nursing Homes: Affordable, Attainable, & Necessary
Good facilities already provide at least 24-hour registered nurses (RNs). The time has come to ensure that all nursing homes provide this level of care and competency. That is why the Biden Administration’s proposal to require that any nursing home that takes public funds have at least one RN in the building 24/7 is so important.
An analysis by the Long Term Care Community Coalition, based on CMS Payroll-Based Journal data from Q1 2023, found that the actual nationwide cost of meeting the 24-hour RN staffing standard is approximately $71 million per year — a fraction of the $610 million figure cited by the nursing home industry. Over 75% of facilities already have sufficient RN hours for 24-hour coverage; the remaining 22.5% could close their gap largely by shifting existing LPN hours to RNs at an incremental cost of roughly $1.09 per resident per day.
— NursingHome411, September 27, 2023
Biden’s Nursing Home Staffing Requirements Are Dangerously Inadequate
Three elder law and long-term care policy experts — from Cornell, UCSF, and the National Consumer Voice for Quality Long-Term Care — argue that the proposed 3.0 total HPRD represents only 73% of the 4.1 HPRD that a CMS-commissioned study found necessary to prevent neglect. They also criticize the proposed waiver structure, which allows facilities to sidestep the minimum by simply paying “prevailing wage” — without offering the higher wages or benefits actually needed to recruit more workers.
— The Hill, September 22, 2023
How Minimum Staffing Standards Empower Nursing Home Workers
USW president Tom Conway highlights how strong state-level staffing standards at the Oregon Veterans’ Home have enabled CNAs to provide not just clinical care but meaningful human connection to residents — and argues that without a federal floor, facilities in states with no staffing requirements will continue to understaff by design. The piece draws a direct line between adequate staffing ratios and reduced worker burnout, improved resident safety, and quality of life, and warns that retiring baby boomers will only intensify demand for nursing home care in coming years.
— CounterPunch, September 22, 2023
Nursing Home Critics Attack Staffing Cost Argument, Urge Providers to Come to the Table
Federal officials and the public need more visibility into nursing home spending to determine whether their concerns about the cost of complying with a nationwide staffing mandate are justified, well-known industry observers said on a Wednesday webinar.
A key to nailing down a firm answer will be crunching more operational data and money numbers, said Harvard health policy expert David Graboswki, PhD.
Harvard health policy expert David Grabowski called the CMS staffing proposal “the biggest reform” nursing homes have faced in decades, arguing that the true cost debate cannot be resolved until the government has better visibility into related-party transactions and private equity flows within the sector. Former SNF chain CEO Michael Wasserman endorsed the rule as implementable regardless of profit status, while NAHCA board chair Sherry Perry urged both facility owners and government to come to the table: “Meet somebody halfway.”
— McKnight’s Long-Term Care News, September 21, 2023
Nursing Home Staffing Rule ‘Balanced and Achievable,’ CMS Official Says
Officials with the Centers for Medicare & Medicaid Services Thursday defended their minimum staffing proposal for nursing homes as “balanced and achievable,” and provided more details on a coming program to build a pipeline of direct care staff.
During the first nursing home stakeholder call since the rule’s September 1 proposal, CMS deputy director Adam Richards defended the staffing minimums and addressed widespread concern about the exclusion of LPNs from hourly requirements. CMS confirmed it would accept comments on a 3.48 total nurse hour alternative that could incorporate LPNs, and that $75 million in civil monetary penalty funds would be committed to building a direct care workforce pipeline through HRSA and state agency partnerships.
— McKnight’s Long-Term Care News, September 15, 2023
An Overdue New Federal Rule to Improve Nursing Home Staffing
What would happen if the federal government were to propose for the first time specific nursing home staffing minimums?
We are about to find out.
James C. Sherlock notes that the proposed rule — the first time the federal government has set hard staffing minimums for nursing homes — would render 245 of 281 Virginia nursing homes non-compliant if in effect today, illustrating the scale of the compliance gap in one state alone. He also highlights the rule’s Medicaid payment transparency provisions, which would require states to publicly report the percentage of Medicaid payments spent on direct care staff — creating a new mechanism for identifying facilities that divert public funding away from resident care.
— Bacon’s Rebellion, September 2, 2023
We Support Strong Nursing Home Staffing Standards
SEIU’s advocacy platform supporting federal minimum staffing standards frames chronic nursing home understaffing not as a workforce shortage but as a business model choice — with some operators reportedly forcing staff to care for 20 to 40 residents at a time while diverting taxpayer dollars away from direct care. The page calls a federal staffing mandate long overdue, citing evidence that most for-profit nursing homes remained profitable during the COVID-19 pandemic even while claiming they could not afford to hire adequate staff.
— SEIU (Service Employees International Union), no date
