On September 1, 2023, the U.S. Department of Health and Human Services (“HHS”) announced important new steps to crack down on nursing homes that endanger resident safety.
The Centers for Medicare & Medicaid Services (CMS) proposed a rule to set a federal floor for staffing levels so that nursing homeowners could not slash staffing to unsafe levels.
If finalized, the proposal would require every facility to have a Registered Nurse on site 24/7, a certain minimum number of registered nurses and nursing aides to provide routine care, and staffing according to resident needs based on a robust assessment of the facility’s residents. To ensure affected nursing homes have ample time to hire necessary staff, CMS proposes that the minimum staffing requirements go into effect in phases.
Staffing levels at nursing homes are closely linked to quality of care.
For instance, a study of one state’s nursing facilities showed that even a 20-minute increase in staffing per resident day from a Registered Nurse was associated with 22% fewer cases of COVID-19 and 26% fewer COVID-related deaths in nursing homes. Other studies similarly find that higher staffing is associated with better quality of patient care and patient health outcomes. Chronic understaffing disproportionately affects facilities serving a higher share of residents from certain racial and ethnic groups. In recent years, there has been a disturbing trend toward private equity firms and other large corporate owners purchasing nursing homes and slashing levels of staff as a way to maximize profits.
To improve nursing home safety in the short term, CMS also announced new efforts to improve enforcement of existing staffing standards, which currently require nursing homes to provide “sufficient” staffing and eight hours per day of registered nurse care. These actions will help address substandard care and strengthen accountability before the new minimum staffing requirements are enacted.
The HHS Office of the Inspector General (HHS-OIG) is also undertaking important oversight of nursing home performance, examining nursing home spending of taxpayer funds, inappropriate prescribing of antipsychotic medications, and emergency preparedness planning by facilities.
In addition, HHS is announcing new steps to help expand the nursing workforce.
CMS, in partnership with the Health Resources and Services Administration (HRSA), announced a national nursing career pathways campaign.
The campaign will help recruit, train, retain, and transition workers into nursing home careers as nursing staff. This plan will invest over $75 million in scholarships and tuition reimbursement.
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