Nursing homes across the U.S. will have minimum staffing level requirements as part of a proposed federal order by the Biden administration to address conditions at the long-term facilities that were ravaged by the COVID-19 pandemic.
Nursing homes will have to provide at least three hours of care to each resident per day, with a percentage from a certified nursing assistant and a smaller portion from a registered nurse, according to the Biden administration.
A nursing home with 100 residents, for example, would need at least two registered nurses on staff for each shift and 10 CNAs, also called nurse aides, per shift to meet the minimum. The requirements also include having a registered nurse on staff 24/7.
Washington’s staffing standards for nursing homes, on average, already exceed the proposed federal staffing minimums. But Friday’s announcement drew mixed reactions among groups affiliated with the state’s approximately 200 nursing homes, which care for roughly 12,000 people.
The announcement comes as President Biden has pledged to improve the country’s long-term care system for the growing aging population, and in the wake of the deadliest days of the COVID-19 pandemic that disproportionately impacted nursing home residents and workers.
About 30% of COVID deaths in Washington are associated with a long-term care facility, which includes nursing homes, assisted-living facilities and adult family homes, according to the Washington state Department of Health.
Washington already requires staff to provide three hours and 24 minutes of direct care to each resident, and nearly all facilities meet that requirement, according to data from the Centers for Medicare & Medicaid Services.
One staffing proposal at the federal level would add up to slightly more than the state’s standard; if adopted, the facilities would be held to the federal standards, according to Jessica Nelson, spokesperson for the Washington state Department of Social and Health Services.
The state doesn’t specify what types of staff need to provide care, so some facilities could be out of compliance under the federal proposals that are specific to CNAs, said Carma Matti-Jackson, president and CEO of the Washington Health Care Association, which represents nursing homes and assisted living facilities.
The proposed requirements could send a mixed message, Matti-Jackson said, and a reduction in face-to-face time with higher-skilled nurses in lieu of more time with CNAs.
“We staff and provide care based on acuity and care needs,” Matti-Jackson wrote in an email. “If more of that care comes from RNs/LPNs [registered nurses and licensed practical nurses] and less of it comes from a CNA — and we are meeting the overall [hours per resident day] requirement — why would that be a bad thing?”
Adam Glickman, secretary-treasurer of SEUI 775, which represents long-term care workers in Washington and Montana, called the proposed rules a “bold positive step” to improve staffing and quality care. He noted the Washington Legislature made initial steps to improve wages for direct care workers, but added that nursing homes remain underfunded.
The Legislature in the last session included increases in Medicaid rates, including $215.3 million for nursing homes.
