Biden's Federal Staffing Mandate For Nurses and CNAs in Long Term Care Announced

In a groundbreaking move aimed at improving the quality of care in nursing homes across the United States, the Biden administration has announced new federal staffing requirements for long-term care facilities that receive Medicare or Medicaid funding. This historic rule is a first of its kind and marks the first time the federal government has mandated specific staffing levels for nursing homes. The requirements specifically address Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nursing Assistants (CNA). 

The New Standards

The new rule, announced by the Centers for Medicare & Medicaid Services (CMS), sets minimum staffing levels that nursing homes must meet to continue receiving federal funds. 

Minimum Staffing Rule Key Points:

• Facility type: Nursing homes and long-term care facilities receiving federal funding through Medicare and Medicaid must adhere to staffing standards.
  • Total Staffing Guidelines: 3.48 hours per resident per day required.
    Breakdown: Includes 0.55 hours per resident per day for registered nurses and 2.45 hours per resident per day for nurse aides.
  • Example: A facility with 100 residents needs at least two or three RNs and ten or eleven nurse aides per shift, plus two additional nurse staff  (which could be registered nurses, licensed professional nurses, or nurse aides) 
• Flexibility: Facilities may need to exceed minimum requirements based on residents' needs.
• Onsite Registered Nurse: Required 24/7 to provide skilled nursing care for enhanced safety.
• Impact: Adequate staffing is crucial for safety and quality care outcomes.

Implementation Phases:

• Phased Introduction: Requirements are introduced gradually to allow time for hiring.
• Rural Communities: Longer timeframes provided for compliance in rural areas.

Exemptions:

• Temporary Exemptions: Limited exemptions are available for nursing homes facing workforce shortages.
• Good Faith Effort: Exemptions granted to facilities demonstrating efforts to hire necessary staff.

Cracking Down Unsafe Staffing

The move follows through on President Biden's pledge to crack down on nursing homes that endanger resident’s safety, an issue that was amplified during the pandemic. As nursing homes grappled with outbreaks and staffing shortages, concerns about the quality of care provided to residents intensified, prompting calls for reform. Biden’s Executive Order Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers also included a list of executive actions to improve care for senior citizens. 

Addressing Staffing Shortages

One of the primary goals of the new rule is to address the persistent staffing shortages that have plagued the nursing home industry. According to a report by the Department of Health and Human Services, nearly one-quarter of nursing homes reported a shortage of nurses or aides, though, this number is likely higher due to vast under-reporting. 

“This rule will not only benefit residents and their families, it will also ensure that workers aren’t stretched too thin by having inadequate staff on site, which is currently a common reason for worker burnout and turnover. Workers who are on the frontlines interacting with residents and understanding their needs will also be given a voice in developing staffing plans for nursing homes. The Biden-Harris Administration also continues to invest in expanding the pipeline of nursing workers and other care workers, who are so essential to our economy, including through funding from the U.S. Department of Health and Human Services,” reads the statement released by the White House.

Implementation and Enforcement

The new staffing requirements are set to take effect in two phases. The first phase, which requires nursing homes to have a registered nurse on-site for at least eight hours per day, will go into effect in 2024. The second phase, which mandates 4.1 hours of care per resident per day, will be implemented in 2026.

CMS has stated that it will closely monitor nursing homes' compliance with the new rules and take enforcement actions against facilities that fail to meet the requirements. Potential penalties include fines, denial of payment for new admissions, and termination from the Medicare and Medicaid programs in cases of severe or repeated noncompliance.

As the implementation of the new staffing rules begins, all eyes will be on the nursing home industry and its ability to meet the new standards. While the road ahead may be challenging, advocates and policymakers alike hope that these reforms will pave the way for improved care and quality of life for the millions of Americans residing in nursing homes across the country.

Reactions From Nurses and Organizations

The announcement has been met with a mix of reactions from stakeholders in the healthcare industry. While patient advocacy groups and some healthcare professionals have applauded the move as a necessary step to improve care, nursing home operators have raised concerns about the potential financial burden and challenges in recruiting and retaining staff.

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However, the American Health Care Association (AHCA) and National Center For Assisted Living (NCAL), have criticized the rule as unrealistic and potentially damaging to an already strained industry. On September 06, 2023, they released a joint press release condemning the proposed rule. 

"This unfunded mandate doesn't magically solve the nursing crisis," Mark Parkinson, AHCA President, told NPR.

The American Healthcare Association (AHCA), released the following statement in 2023 while the proposal was still being considered, “We are concerned that in proposing a one-size-fits-all numerical staffing threshold, CMS would remove the role of clinical judgment in staffing facilities, and inadvertently create patient access challenges across the health care system. Implementing a numerical staffing threshold could drive nursing homes to further reduce capacity or close in order to meet the requirements. Fewer nursing home beds could adversely impact hospital patients who are denied the specialized care they are prescribed when they must stay, sometimes months, in hospital beds awaiting discharge to post-acute care settings. This could become especially dire in rural and underserved communities.”