In a bipartisan effort to address the ongoing staffing crisis in the nation’s nursing homes, U.S. Senators Bob Casey (D-PA) and Ron Wyden (D-OR) have taken the lead in urging the Center for Medicare & Medicaid Services (CMS) to finalize and implement proposed rules aimed at setting minimum staffing requirements for nursing homes. This step is seen as crucial in ensuring the safety and well-being of the 1.2 million residents in these facilities.
The Senators assert that the connection between staffing levels in nursing homes and the quality of care provided has been well-documented. Studies have consistently shown that inadequate staffing results in lower quality care for residents. Notably, a report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found that higher nurse staffing ratios were associated with better outcomes, particularly during disease outbreaks like the COVID-19 pandemic. Moreover, a recent Department of Health and Human Services (HHS) Office of Inspector General (OIG) report recommended the establishment of minimum staffing requirements in response to the devastating impact of the pandemic on nursing home residents.
The proposed rule, championed by Senators Casey and Wyden, seeks to establish commonsense staffing minimums and improve enforcement. Many states already have nursing home minimum staffing standards in place that align with or surpass those outlined in the proposed rule, indicating that it is a practical and achievable goal.
Recognizing the complexity of implementing a meaningful minimum staffing requirement, the proposed rule calls for careful consideration of various factors, such as variations in patient acuity, rural challenges, and workforce availability. The Senators emphasize the importance of including Licensed Practical Nurses (LPNs) in the final rule, as they play a critical role in providing bedside care to nursing home residents.
The proposed rule also introduces a requirement for a Registered Nurse (RN) to be onsite 24/7, a measure supported by multiple safe staffing studies. However, the Senators acknowledge that some facilities may struggle to meet this requirement, especially in rural areas. They encourage CMS to seek input from stakeholders and explore ways to address these concerns without compromising the clinical goals of the proposal.
The Senators also appreciate CMS’s efforts to support the nursing home workforce through investments in training and workforce development. They suggest further collaboration with states and exploring state-run training programs to bolster the long-term care workforce.
Another key aspect of the proposed rule is requiring state Medicaid agencies to report the percentage of payments allocated to compensation for direct care workers and support staff. This transparency is expected to shed light on the relationship between wages and staff turnover, helping improve the quality of services received by Medicaid beneficiaries.
Lastly, the Senators emphasize the importance of robust oversight and enforcement of staffing standards, a task that has been underfunded and understaffed for years. Delayed oversight can lead to slower responses to complaints and jeopardize resident health and safety. They urge CMS to allocate adequate resources to state survey agencies for this essential work.
