Federal Nursing Home Staffing Standards to Increase Care Hours for Residents

Minimum staffing requirements will “help protect the basic rights of residents to live in dignity” and is long overdue, especially for facilities that are funded through taxpayer dollars, Nancy LeaMond, AARP’s executive vice president and chief advocacy and engagement officer, said in a statement.

“Far too many residents and families have experienced tragic consequences because of poorly staffed facilities,” LeaMond said in the statement, adding that “ensuring nursing homes are adequately staffed will improve the quality of care residents receive and can give family caregivers peace of mind, knowing their loved ones are living with the quality of life they deserve.”

More staff likely needed

Many nursing home facilities will need to hire staff to meet the new requirements, the White House said, noting that a facility with 100 residents would need two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift to meet the new standards.

President Joe Biden pushed for minimum staffing levels in nursing homes in his 2022 State of the Union address. The COVID-19 pandemic highlighted long-term problems in nursing homes, including the decline in staffing, issues regarding infection control deficiencies and inadequate oversight.

Current law requires facilities to have licensed nursing services around the clock that are “sufficient” to “maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”

Nursing home industry groups said the new rule and requirements will be hard to meet because of staff shortages.

The American Health Care Association (AHCA), a national lobbying group representing more than 14,000 long-term care providers, issued a statement calling the rule “an unreasonable standard.” The group said the new staff requirements could lead to nursing home shutdowns and the displacement of residents.

“Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers,” the AHCA said in a statement. “This unfunded mandate doesn’t magically solve the nursing crisis.”

The new staffing requirements will be introduced in phases, with rural communities given a longer time to comply, according to the White House. Limited, temporary exemptions also will be available for the around-the-clock nurse requirement and the staffing standards in areas where there are workforce shortages and a good faith effort to hire.

The announcement Monday comes one month after a federal government report highlighted lessons learned from the pandemic for nursing homes and found that CMS should do more to prevent staffing shortages in nursing homes and strengthen infection controls to better protect residents after the COVID-19 pandemic.

Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy, a legal nonprofit working to advance access to health care coverage, said the new rule doesn't end the discussion of staffing levels. Each facility must annually conduct an assessment to determine the nursing needs of its residents and to ensure it has enough staff with the skills to meet those needs.

"Properly implemented and enforced, the facility assessment process will require many facilities to implement higher staffing levels than the minimums announced today," he said in a statement.