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Biden Administration Proposes Minimum Staffing Rules for Nursing Homes

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Biden Administration Proposes Minimum Staffing Rules for Nursing Homes

In a significant move aimed at addressing long-standing concerns about neglect and abuse in the nursing home industry, the Biden administration has released a proposed Minimum Staffing Rules for Nursing Homes across the nation to maintain levels of front-line caregivers. This proposal comes after years of complaints and signals the administration’s commitment to improving the quality of care for seniors, especially as the baby boomer generation continues to age.

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The Delayed Promise:

The proposed rule, if implemented as planned, will fulfill a promise made by President Biden in his 2022 State of the Union speech. However, its release faced several months of delay due to intense lobbying efforts by industry trade groups. These groups argue that mandatory staff levels are unrealistic and financially burdensome due to the severe shortage of skilled staff in the industry.

Challenges Ahead:

While the proposed rule has faced criticism from industry stakeholders, it also falls short of the expectations of advocates for better care in nursing homes. They are concerned that the rule may not go far enough to address the chronic issue of understaffing, potentially perpetuating mediocre levels of care.

Key Provisions:

The proposed rule outlines specific staffing requirements, including that each resident must receive 2.45 hours of care from a nurse aide per day, in addition to 0.55 hours of care from a registered nurse. While these requirements represent an improvement, they still fall short of a government study’s recommendation from two decades ago, which suggested a daily minimum of 4.1 hours per resident for quality care.

Biden Administration Proposes Minimum Staffing Rules for Nursing Homes

Furthermore, nursing homes would be required to have a registered nurse on duty at all times. This requirement would necessitate that approximately one-fifth of nursing homes hire additional registered nurses to meet the standard.

Secretary of Health and Human Services Xavier Becerra emphasized that these staff minimums are essential to ensure that residents receive the care they deserve. The Centers for Medicare and Medicaid Services, responsible for overseeing nursing homes and drafting the rule, estimates that approximately 75 percent of nursing homes will need to increase staffing to meet these requirements.

Industry Concerns:

Nursing home operators have been vocal about the challenges they face, citing a severe shortage of front-line caregivers, exacerbated by the COVID-19 pandemic, which resulted in the loss of 250,000 workers. They argue that without a sufficient supply of prospective workers and increased Medicaid reimbursement rates, meeting the proposed staffing requirements will be nearly impossible.

Concerns in Rural Areas:

To address the unique challenges faced by rural nursing homes with limited access to staff, the Biden administration has included exemptions in the rule. Facilities in rural areas that can demonstrate good faith efforts to recruit and retain workers but still face staffing shortages would be granted exemptions.

Biden Administration Proposes Minimum Staffing Rules for Nursing Homes

Retention vs. Hiring:

Advocates for improved nursing home care stress that the real issue lies in high staff turnover rates, which are a result of insufficient pay and poor working conditions. Many front-line caregivers, primarily women of color, earn low wages, leading them to work in multiple nursing homes simultaneously to make ends meet.

Conclusion:

The proposed rule by the Biden administration represents a significant step towards improving the quality of care in nursing homes, but it also highlights the complex challenges faced by the industry. While it seeks to address longstanding issues of neglect and abuse, it faces opposition from industry groups concerned about feasibility and cost. Advocates, on the other hand, argue that the root problem lies in the treatment and compensation of front-line caregivers. As the proposal undergoes further review and debate, it remains to be seen how these issues will be resolved to ensure better care for the 1.2 million nursing home residents in the United States.

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FAQ – Proposed Minimum Staffing Rules for Nursing Homes

  1. What is the main objective of the proposed rule for nursing homes?

    The proposed rule aims to establish minimum staffing requirements for nursing homes across the United States. It intends to address longstanding concerns about neglect and abuse in the industry, ultimately improving the quality of care for seniors, especially as the baby boomer generation ages.

  2. Why was the release of this rule delayed?

    The release of the rule faced months of delay due to extensive lobbying efforts by industry trade groups. These groups argued that mandatory staff levels would be unrealistic and too costly due to the severe shortage of skilled staff in the nursing home industry.

  3. What are the key provisions of the proposed rule regarding staffing requirements?

    The proposed rule requires that each nursing home resident receive 2.45 hours of care from a nurse aide per day, in addition to 0.55 hours of care from a registered nurse. It also mandates that nursing homes have a registered nurse on duty at all times. However, these requirements fall short of what a government study recommended two decades ago (4.1 hours per day).

  4. How would this rule impact nursing homes that currently do not meet these staffing standards?

    The Centers for Medicare and Medicaid Services estimate that approximately 75 percent of nursing homes will need to increase staffing to meet the proposed requirements. This could mean hiring more nurse aides and registered nurses.

  5. What concerns do nursing home operators have regarding this rule?

    Nursing home operators have expressed concerns about the shortage of front-line caregivers, particularly exacerbated by the COVID-19 pandemic, which resulted in the loss of 250,000 workers. They argue that without an adequate supply of prospective workers and increased Medicaid reimbursement rates, meeting the proposed staffing requirements will be challenging.

  6. How does the rule address staffing challenges in rural areas?

    To address staffing challenges unique to rural nursing homes, the proposed rule includes exemptions for facilities that can demonstrate good faith efforts to recruit and retain workers but still face staffing shortages.

  7. Why do advocates for better nursing home care believe the real problem lies in staff turnover?

    Advocates argue that high staff turnover rates in nursing homes result from insufficient pay and poor working conditions. Front-line caregivers, many of whom are women of color, often earn low wages, leading them to work in multiple nursing homes simultaneously to make a decent living.

  8. What is the next step for this proposed rule?

    The proposed rule will undergo further review and debate. The outcome will determine how the United States addresses the complex challenges facing the nursing home industry and ensures better care for the 1.2 million nursing home residents in the country.

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