Nursing homes must meet minimum federal staffing levels under Biden rule

 Most U.S. nursing homes will need to add staffing under a federal rule announced Monday that for the first time sets minimum staffing ratios nationwide for homes that care for elderly and disabled people.

The rule, announced Monday by Vice President Kamala Harris, mandates that nursing homes meet minimum staffing requirements for registered nurses and nurse aides. The rule is intended to limit cases of resident neglect or delays in care, a lingering issue that was exposed when more than 200,000 nursing home residents and staff died from COVID-19 in the first two years of the pandemic.

Experts call the rule a significant step toward bolstering nursing home quality and safety.  

“This is the most important nursing home reform in decades,” said David Grabowski, a professor of health care policy at Harvard Medical School. “We need more staff in nursing homes. This is a big development in terms of setting a floor such that nursing homes can’t grossly understaff facilities.”

Mark Parkinson, president and CEO of the nursing home industry group American Health Care Association, blasted the rule as "unconscionable" given the nation's nursing shortage.

"Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers," Parkinson said in a statement. "This unfunded mandate doesn’t magically solve the nursing crisis."

The White House said in a fact sheet the new rule requires all nursing homes receiving federal funding through Medicare and Medicaid to provide staffing that is the equivalent of nearly 3.5 hours of daily care for each resident. The rule also requires that nursing homes have registered nurses on duty 24 hours, seven days a week to "provide skilled nursing, which will further improve nursing home safety."

On average, a nursing home with 100 residents would have two to three registered nurses and at least 10 nurse assistants on duty for each shift around the clock. Officials said this level of staffing is necessary to provide safe care with good outcomes for vulnerable residents.

The Biden administration said the rule will be implemented in phases to give nursing homes, especially those in rural communities, time to hire the additional workers. Nursing homes in communities facing a workforce shortage will get "limited, temporary exemptions" to meet the registered nurse requirement and overall staffing ratios, the White House said.

Federal and academic researchers have long established staffing levels as the best predictor of quality nursing home care. However, the Centers for Medicare & Medicaid Services, which regulates nursing homes that take Medicare and Medicaid funding, has never required a specific number of nurses and aides. The agency has only made recommendations which few facilities followed.

In a related rule also announced Monday, the Biden administration seeks to bolster home care for seniors and disabled residents on Medicaid, the federal health program for low-income populations. The rule requires companies that provide home care services spend a minimum of 80% of Medicaid payments on workers' wages.

The Biden administration said higher wages for home health care workers would reduce turnover and lead to higher quality home care for the elderly and disabled.

The home care rule, which is similar to the rule on nursing home staffing ratios, would allow states to account for "unique experiences that small home care providers and providers in rural areas face" in meeting such requirements, the White House said.

USA TODAY investigation found that although nursing homes have submitted daily staffing data to federal officials for years, they have rarely been punished for violating the existing guidelines and rules. 

Such penalties have been unusual even at facilities where inspectors noted low staffing in the course of investigating avoidable deaths, and people who'd suffered broken bones, spent days without help getting out of bed or hours sitting in feces, among other violations. Fines for such violations have been even rarer. 

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