Nursing home staffing will be federally regulated for the first time in response to systemic COVID-19 deaths

The federal government will, for the first time, set staffing levels in nursing homes, the Biden administration said on Sept. 1, responding to systemic problems arising from mass COVID-19 deaths.

While such regulation has been sought for decades by allies of older adults and people with disabilities, the proposed limit is far lower than many advocates had expected. It also immediately angered the nursing home industry, which said it was a mandate that could not be met.

With criticism expected, details of a promise made with fanfare in President Joe Biden’s 2022 State of the Union speech emerged as many Americans turned away from the news for the holiday weekend.

“Establishing minimum staffing standards for nursing homes will improve the safety of residents,” Health Secretary Xavier Becerra said in a statement. “When facilities are understaffed, residents suffer.”

The proposed rules, which are now entering the public comment period and will take several years to fully take effect, call for the equivalent of 3 hours of staffing per resident per day, just over half an hour from registered nurses. Is. The rules also state that staff must have an RN on staff 24 hours a day.

According to government reports, the average American nursing home already has about 3.6 hours of caring staff per day per resident, with RN staffing just above the half-hour mark.

Still, the government insists that most of the country’s roughly 15,000 nursing homes, which house about 1.2 million people, would have to add staff under the proposed rules.

Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services, or CMS, called the move “an important first step.” CMS oversees nursing homes.

A senior White House official, speaking on condition of anonymity before the announcement, said the Biden administration is prepared to revisit the staffing limits once they are implemented.

Becerra aide Stacey Sanders said, “I would caution anyone who thinks that the status quo — in which there is no federal level for nursing home staffing — is preferable to the standards we have proposed.” “This standard will increase staffing levels for nursing homes by more than 75%, bring more nurse aides to the bedside and ensure that every nursing home has a registered nurse on site 24/7.”

The new limits are well below those long eyed by advocates after a landmark 2001 CMS-funded study recommended an average of 4.1 hours of nursing care per day per resident.

Most US facilities do not meet that limit. Many advocates said that even this was inadequate, taking into account quality of life, determining only the point at which residents could face potential harm.

After the Democratic president raised the issue in his State of the Union speech, advocates were initially excited, expecting the most significant changes for residents since the Nursing Home Reform Act of 1987. That changed after a copy of a new study funded by CMS. The topic was posted anonymously this week, claiming that “there is no clear plateau at which quality and safety are maximized.”

The advocates were disappointed, saying that they had been betrayed by administrative officials whom they considered allies. As soon as the proposal became public, things became more acrimonious.

Richard Mollot, who leads the Long-Term Care Community Coalition, called it “grossly inadequate” and a blown “once-in-a-generation opportunity” that lacks “any evidence of what residents need.” ignores” and fails to fulfill it. The heart of Biden’s promise. He reluctantly acknowledged that the 24/7 RN rule might bring small improvements in the worst facilities, but was otherwise mild in his criticism.

Calling the move “heartbreaking” and “nauseating”, he said it would do more harm than good, put a government seal on poorly staffed homes and risk wrongful-death lawsuits.

“This is a tremendous dereliction of duty,” he said. “We are continuing to allow nursing homes to warehouse people and rob the public.”

Katie Smith Sloan, principal of LeadingAge, which represents nonprofit nursing homes, said creating a rule requiring facilities to hire additional staff was redundant when the industry was already in a workforce crisis and ” There are no people for it.”

“To say we are disappointed that President Biden decided to move forward despite clear evidence against the proposed staffing ratios is an understatement,” he said.

Current law only requires that homes have “adequate” staff, but leaves almost all interpretation up to the states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low-level that advocates say they are meaningless, and, across the board, enforcement is often toothless.

The problem has long been apparent to front-line nurse aides — the underpaid, overwhelmingly female and disproportionately minority backbone of the facility staff — and to the residents themselves, whose call bells go unanswered, whose showers go short. Goes and waits for food for those who are hungry.

The coronavirus pandemic, which has killed more than 167,000 US nursing home residents, has drawn the most attention to poor staffing in history. But, in view of this, the number of employees in many homes reduced even further.

Across all job types, Bureau of Labor Statistics data shows there are 218,200 fewer workers in nursing homes than in February 2020, when the first outbreak of the coronavirus in the US reached a nursing home outside Seattle.

The largest lobbyist on behalf of nursing homes, the American Health Care Association, has waged a tireless campaign, claiming that facilities are underfunded, Medicaid subsidies are inadequate, there are rampant recruitment and retention issues and the homes are overcrowded. are closed, and it warned that staffing mandates will only exacerbate those problems. issues. But there has been no sign of widespread closures, the profitability of the houses has been repeatedly highlighted and critics have argued, if they were paid better, workers would come.

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