The federal government is for the first time requiring nursing homes to have minimum staffing levels after the COVID-19 pandemic exposed grim realities in poorly staffed facilities for older and disabled Americans.
Vice President Kamala Harris announced the final rules on Monday before a trip to La Crosse, Wisconsin, where she will talk to nursing home care employees about their work. In the battleground state, Harris also will hold a campaign event focused on abortion rights.
President Joe Biden first announced his plan to set nursing home staffing levels in his 2022 State of the Union address, but his Democratic administration has taken longer to nail down a final rule as health care worker shortages plague the industry. Current law only requires that nursing homes have “sufficient” staffing, leaving it up to states for interpretation.
The new rules implement a minimum number of hours that staff members spend with residents. They also require a registered nurse to be available around the clock at the facilities, which are home to about 1.2 million people. The rules dictate that 80% of Medicaid payments for home care providers go to workers’ wages.
Allies of older adults have sought the regulation for decades, but the rules will most certainly draw pushback from the nursing home industry.
The nursing home care event will mark Harris’ third visit to the battleground state this year and is part of Biden’s push to earn the support of union workers. Republican challenger Donald Trump made inroads with blue-collar workers in his 2016 victory. Biden regularly calls himself the “most pro-union” president in history and has received endorsements from leading labor groups such as the AFL-CIO, the American Federation of Teachers and the American Federation of State, County and Municipal Employees.
Harris will gather nursing home care workers at an event Monday joined by Chiquita Brooks-Lasure, administrator of the Centers for Medicare and Medicaid Services, and April Verrett, secretary-treasurer of the Service Employees International Union.
The coronavirus pandemic, which claimed more than 167,000 nursing home residents in the U.S., exposed the poor staffing levels at the facilities and led many workers to leave the industry. Advocates for the elderly and disabled reported residents who were neglected, going without meals and water or kept in soiled diapers for too long. Experts said staffing levels are the most important marker for quality of care.
The new rules call for staffing equivalent to 3.48 hours per resident per day, just over half an hour of it coming from registered nurses. The government said that means a facility with 100 residents would need two or three registered nurses and 10 or 11 nurse aides as well as two additional nurse staff per shift to meet the new standards.
The average U.S. nursing home already has overall caregiver staffing of about 3.6 hours per resident per day, including RN staffing just above the half-hour mark, but the government said a majority of the country’s roughly 15,000 nursing homes would have to add staff under the new regulation.
The new thresholds are still lower than those that had long been eyed by advocates after a landmark 2001 study funded by the Centers for Medicare and Medicaid Services, or CMS, recommended an average of 4.1 hours of nursing care per resident daily.
The government will allow the rules to be introduced in phases with longer timeframes for nursing homes in rural communities and temporary exemptions for places with workforce shortages.
When the rules were first proposed last year, the American Health Care Association, which lobbies for care facilities, rejected the changes. The association’s president, Mark Parkinson, a former governor of Kansas, called the rules “unfathomable,” saying he was hoping to convince the administration to never finalize the rule.
