Proposed Staffing Norms Are A Hurdle for Majority of Nursing Homes
New Staffing Proposals Leave Many Nursing Homes Scrambling
By: Catie Hillard
September 27, 2023 – Recent data from a KFF brief shines a spotlight on a rather startling fact – only 19% of nursing homes are in line with the new staffing standards proposed for long-term care facilities.
Earlier this month, the CMS unveiled a potentially game-changing rule. It’s packed with three main staffing requirements for nursing homes that accept Medicare and Medicaid patients. The proposed standards dictate that each resident needs to be provided a minimum of 0.55 hours of daily care from a registered nurse (RN), with an additional 2.45 hours from a nursing aide. That’s not all – nursing homes are expected to have an RN present 24/7 and should also regularly perform in-depth facility evaluations concerning staffing.
To dive deep into how the industry fares in the light of these propositions, KFF analyzed data on almost 15,000 nursing establishments. And the verdict? A staggering 81% of them would need to boost their staff to make the cut.
Breaking it down further, about 52% of these nursing homes do hit the mark for the proposed RN hours per resident. But when it comes to nurse aides, only 28% stand compliant. The business model appears to have a say in this too. Most profit-driven nursing homes would need to ramp up their hiring, in contrast to 60% of their counterparts in the government and non-profit arenas.
And here’s where it gets even more intriguing: the geographical spread. Take Louisiana, for instance, where the compliance is almost zero. However, head north to Alaska, and every single nursing facility meets the benchmark. Across over half of the states, less than a quarter of facilities stand compliant. And while 16 states see compliance rates between 25% and 49%, only six states boast over 50% of nursing homes meeting the standards.
Now, what causes these variations? “Variation across the states is likely to reflect many factors, including what percentage of facilities are for-profit, the availability of RNs and nurse aides in the state, and state requirements regarding minimum staffing levels,” the brief noted.
While debating on these standards, CMS brought another factor into the mix: whether nursing homes should maintain a daily staffing level of 3.48 hours for every resident. Factoring in the 0.55 hours from RNs and the 2.45 hours from nursing aides, the final 0.48 hours could be covered by any nursing staff member. Surprisingly, the numbers don’t differ much with this alternative, with only 18.9% of homes meeting this mark.
CMS also contemplated a case-mix adjustment, focusing on facilities with residents requiring more intensive care. If executed, a meager 0.3% (or 38 facilities) would be compliant with the requirements for RNs and nursing aides.
But here’s the real issue. Should these proposed rules get the green light, the nursing home sector could be up for a challenging time, especially with the ongoing staff crunch. The associated costs will spike, with estimates hinting at an extra $40 billion in a decade post-rule implementation. And who’s going to foot this hefty bill? Health plans and, more importantly, the residents might be the ones bearing the brunt.
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