Texas Could Block Federal Nursing Home Staffing Rule, AG Files Lawsuit
Texas Attorney General Ken Paxton has filed a lawsuit against the Biden administration, seeking to block a new federal rule that mandates minimum staffing levels for nursing homes. Paxton argues that the rule fails to account for the nationwide nursing shortage, making compliance practically impossible for many long-term care facilities. He claims the administration has not provided justification for the need for such rules. The lawsuit alleges that the staffing requirements would force rural nursing homes out of business due to their inability to meet the mandated staffing levels amid the severe workforce shortage in the industry.
About The Staffing Rule
The staffing rule, announced by the Center for Medicare and Medicaid Services in April 2024, requires nursing homes to have a registered nurse on-site for at least eight hours per day, seven days a week. Additionally, it mandates specific staffing levels for other nursing staff, such as licensed practical nurses and certified nursing assistants. The rule is aimed at improving the quality of care in nursing homes by ensuring adequate staffing levels.
According to the CMS website, long-term care facilities (LTC) must adhere to the following rules:
- Minimum Direct Nursing Care Requirement: Facilities must provide at least 3.48 hours per resident day (HPRD) of direct nursing care.
- Registered Nurse (RN) Care: At least 0.55 HPRD must be provided by registered nurses (RNs).
- Nurse Aide Care: At least 2.45 HPRD must be provided by nurse aides.
- Flexible Staffing: The remaining 0.48 HPRD required to meet the total 3.48 HPRD standard can be fulfilled using any combination of nursing staff, including RNs, licensed practical nurses (LPNs), licensed vocational nurses (LVNs), or nurse aides.
Rural Nursing Homes
In the lawsuit, Paxton argues that the staffing requirements could force rural nursing homes out of business due to their inability to meet the mandated staffing levels amid the severe workforce shortage in the industry. He claims that the Biden administration has not provided sufficient justification for the need for such rules or taken into account the practical challenges faced by nursing homes in hiring and retaining qualified staff.
“This power grab by Biden’s health bureaucrats could put much-needed care facilities out of business in some of the most underserved areas of our state,” said Attorney General Paxton. “We are taking the federal government to court over this rule that could worsen rural care shortages by shutting down facilities due to new hiring quotas that are impossible to fill.”
Long-Term Care Staffing Crisis
According to a report by the American Health Care Association (AHCA), nursing homes have experienced the most job losses of any healthcare sector. Further analysis by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) reveals more in-depth findings,
- Significant Job Loss: Nursing homes lost 210,000 jobs during the pandemic.
- Workforce Levels: Staffing is at its lowest since 1994.
- Slow Recovery: Job growth in 2022 was slower than expected, averaging 3,700 jobs per month.
- Delayed Recovery: Nursing homes may not reach pre-pandemic job levels until 2027.
- Worst-Affected Sector: Nursing homes faced the worst job loss among healthcare sectors and have not rebounded like other industries.
The So-Called Nurse Staffing Shortage
It's no secret that nurses are leaving the profession, but it's a stretch to call the current circumstances a true shortage. There are 5 million licensed nurses in the country, but not all of them are working. Many nurses are refusing to work in their profession due to systemic issues that caused them to leave the profession in the first place.
According to Nurse.org's State of Nursing Report 2023, we asked nurses a series of questions about how they feel about the nursing profession.
When asked “What do you think are the primary causes of the nursing shortage?” here's how nurses responded,
- Nurses are burned out - 74%
- Poor working conditions - 58%
- Inadequate pay for nurses - 57%
- Lack of appreciation for nurses - 34%
When asked “What do you think would make the biggest impact on the nursing shortage” 71% of nurses replied that improved staffing ratios would have the biggest impact, followed by better pay (64%) and better working conditions (41%).
The full report reveals key findings about the current state of nursing and how actual nurses are feeling. Addressing the nursing shortage requires a compassionate, multi-faceted approach that not only offers immediate relief to improve nurses' daily lives but also focuses on long-term solutions to tackle the root causes of the issue.
If the lawsuit is successful, it could delay or derail the implementation of the staffing rule, potentially leaving nursing home residents without the intended protections. However, if the rule is upheld, it could put additional strain on already struggling nursing homes, particularly in rural areas, and potentially lead to facility closures or reduced access to care for seniors.
